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WINTER 2001 






LEGACY 


UmB 



The late Richard Warren, 
Class of 1 934, stands 
in the old site of the 
Warren Anatomical 
Museum, one of the 
many legacies left by 
his family of eminent 
surgeons, whose connec- 
tions to HMS spanned 
more than two centuries. 
Treasures exhibited in the 
new museum site are 
featured on page 42. 



WINTER 2001 • VOLUME 74, NUMBER 3 



C ONTENT S 




DEPARTMENTS 



Letters 3 

Pulse 6 

HMS at the miUeimiuin; a new teaching 
academy 

President's Report 9 

by Charles j.Hatem 

Bookmark 10 

A review by EHssa Ely of 30 Secrets of 
the World's Healthiest Cuisines 

Bookshelf 11 

Benchmarks 12 

A popular computer game demonstrates 
a vital hnk between sleeping and learning. 
by Misia Landau 

Alumna Profile 56 

Nawal Nour teaches physicians how to 
treat women who have been circumcised. 
by Susan Cassidy 

Class Notes 58 

InMemoriam 61 

Hermann Lisco 

InMemoriam 62 

Guillermo Sanchez 

Obituaries 63 




SPECIAL REPORT: TO THE ENDS OF THE EARTH 



On Top of the World 14 

A physician indulges a passion for adventure and bestows the 
gift of sight in the Himalayas. 

b}' BEVERLY BALLARO 

Broken Silences 20 

During his quest to prevent severe hearing loss among Inuit hunters in 
Greenland, a neurophysiologist gains long-overdue recognition for the 
co-discoverer of the North Pole. 

b)' PAULA BYRON 

Northern Exposure 26 

Exploring the Arctic by dogsled, in Alaskan villages, and on board a Russian 
icebreaker, three physicians discover the enchantments of the far north. 

by PAUL A BYRON 

Breaking the Ice 32 

An anesthesiologist uncovers medical clues in the unlikehest of 
settings — the Antarctic. 

by SUSAN CASSIDY 

Cold Comfort 36 

As two HMS alumni know only too well, summitting a mountain is 
only half the battle; you need to be able to descend safely as well. 

b}" BEVERLY BALLARO 

On Call in the Wild 

How can physicians incorporate adventure 
into their hves — and medicine into 
their adventures? 

by BEVERLY BALLARO 



FEATURES 



Unburied Treasures 

The newly displayed artifacts in Harvard's 
Warren Anatomical Museum reveal both 
the outer Umits and the ingenuity of 
medicine on the threshold of modernity. 

by VIRGINIA HUNT 

Quest for the West 

The Rocky Mountain West tantalized 
nineteenth-century American setders with 
twin visions of health and wealth. 

by BETTY ANNE JOHNSON 



Cover photograph: Geoff Tahin '84 summits Denali 




Harvard Mediml 



A L U M N 



U L L E T I N 



In This Issue 

■■■■■jH HEN I WAS A LITTLE GIRL, JUST BEGINNING TO READ, I CAME ACROSS A 

^^Tnfl book on the Civil War. In those pages I learned, with growing 
^^^^^1 alarm, that the conflict had been waged between the North and 
^H^l^H the South. Without waiting to read more, I ran to my mother and 
asked who had won. When she answered, "The North," I was greatly relieved. 
At 330 miles above the Arctic Circle, my hometown of Barrow, Alaska — the 
northernmost point of the United States — had won the war. 

Although my sense of American history has since improved, my passion for 
the far north has remained unchanged. In this issue of the Bulletin, we track the 
exploits of physicians whose passions for the ends of the earth have led to adven- 
ture. We begin with Geoff Tabin '84, a mountain- climbing, bungee-jumping 
ophthalmologist who has been caUed "a httle crazy" by Sir Edmund Hillary himself. 
Tabin stands at the juncture of adventure and medicine; when not climbing the 
Himalayas, he combats the high prevalence of blindness in Himalayan villages. 

Next we foUow Arctic explorers: S. AUen Counter, an HMS professor who has 
researched severe hearing loss among the Inuit of Greenland; Norman Wilson '63, 
who has dogsledded with Inuit seal hunters in Canada; Georgiana Boyer '55, who 
has conducted chnical visits in Alaskan villages; and Edgar Miller, Jr. '54, who has 
traveled to the North Pole as ship's surgeon on a Russian icebreaker. 

We then head 180 degrees south, to the territory of Warren Zapol, an HMS 
professor who has led nine expeditions to Antarctica in search of clues as to why 
WeddeU seals can stay submerged in water more than 30 times longer than the 
most expert human divers. Zapol believes this incredible feat can teach physi- 
cians valuable lessons about treating the frailties of human physiology. 

Finally, we report on a near-fatal mishap shared by Stephen Arnon '72 and 
George Merriam '75, who were forced to shelter in a mountain crevasse for a 
week, subsisting on candy bars, snow melted by their own body heat, and songs 
remembered from Harvard Glee Club days. 

Not everyone welcomes extreme adventures, of course, for the often bleak and 
inhospitable climates at the ends of the earth can be intimidating. My mother tells 
a story from the 1950s, when there were no doctors at the tiny hospital in Barrow, 
where she and three other nurses provided all the medical care for the community. 
A physician from the Lower 48 was hired at last, and the nurses eagerly went to meet 
his incoming ship. Yet when the doctor caught sight of the treeless tundra, the ram- 
shackle houses, and the ice boulders piled askew on the beach, he refused to disem- 
bark. After reading about the stalwarts portrayed in these pages, however, you wiU 
feel assured that the physician who was cowed by this frozen desolation was a 
graduate of some other medical school. ^ -) ^ — -j 



EDITOR-IN-CHIEF 

William Ira Bennett '68 

EDITOR 

Paula Brewer Byron 

ASSOCIATE EDITOR 

Beverly Ballaro, PhD 

ASSISTANT EDITOR 

Susan Cassidy 

BOOK REVIEW EDITOR 

Elissa Ely '88 



EDITORIAL BOARD 

Rafael Campo '92 

Elissa Ely '88 

Atul Gawande '94 

Robert M. Goldwyn '56 

Perri Klass '86 

Victoria McEvoy '75 

James J. O'ConneU '82 

Nancy E. Oriol '79 
J. Gordon Scannell '40 
Joshua Sharfstein '96 

Eleanor Shore '55 
John D. Stoeckle '47 



DESIGN DIRECTOR 

Laura McFadden 



ASSOCIATION OFFICERS 

Charles J. Hatem '66, president 

Paul J. Davis '63, president-elect 1 

Mitchell T. Rabkin '55, president-elect 2 

Stephen G. Pauker '68, vice president 

Maria C. Alexander- Bridges '80, secretary 

Cecil H. Cosgins '58, treasurer 



COUNCILLORS 

Rafael Campo '92 

Paul Farmer '90 

B. Lachlan Forrow '83 

Michael A. LaCombe '68 

Gina T. Moreno-John '94 

DeWayne M. Pursley '82 

Nanette Kass Wenger '54 

Francis C. Wood, Jr. '54 

Kathryn A. Zufall-Larson '75 

DIRECTOR OF ALUMNI RELATIONS 

Daniel D. Federman '53 

ASSISTANT DEAN FOR ALUMNI 
AFFAIRS AND SPECIAL PROJECTS 

Nora N. Nercessian, PhD 

REPRESENTATIVE TO THE 
HARVARD ALUMNI ASSOCIATION 

Chester d'Autremont '44 

Tile WanarAMcAicai fiumm Biilktin is 

publislied quarterly at 25 Shaccuck Street, 

Boston, MA 02115 <' by the Harvard 

Medical Alumni Association. 

Phone: (617) 432-1548 . Fax: (617) 432-0013 

EmaU: bulletin@hms.harvard.edu 

Third class postage paid at Boston, 

Massachusetts. Postmaster, send form 3579 

to 25 Shattuck Street, Boston, MA 02115 

ISSN 0191-7757 • Printed in the U.S.A. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



?^ 



SECOND OPINIONS FROM OUR READERS 



T/ETTERS 



^ 




Faith Healing 

How intriguing are the various modali- 
ties of physician renewal that are dis- 
played in the summer issue of the Bulletin. 
My professional career has been charac- 
terized by one reviewing physician as 
"variegated," and the process through 
which I have proceeded since medical 
school has certainly been the source of my 
renewal over the years. Having trained in 
internal medicine and pediatrics, I under- 
took fellowships in genetics and rheuma- 
tology. Some years later, I returned to 
school at the Lhff School of Theology in 
Denver, receiving a master's degree in 
rehgious studies, with an emphasis on 
biomedical ethics. During those studies, I 
also became intensely interested in the 
spiritual aspects of health care, and I inte- 
grated that into my medical practice of 
chronic pain management. 

In my personal search for optimal 
health, I have incorporated nutritional 
information on the importance of a 
low- fat diet and use of vitamin and 
mineral supplements, studies of physi- 
cal fitness that included training in the 
practice of tai chi, and the development 
of a regimen of meditation and prayer. 
One specific daily prayer is a modifica- 
tion of the so-called "Serenity Prayer," 



as follows: "Oh God, grant me the 
serenity and inner harmony to accept 
the things I cannot change; grant me 
the strength and courage to change the 
things I can; and grant me the wisdom, 
discernment, and humility to know the 
difference." 

THOMAS C. WASHBURN '57 
BRADENTON, FLORIDA 

More than a Passing Glance 

I thoroughly enjoyed the summer issue 
of the Bulletin. Normally, I only glance at 
the articles and look for classmates in 
the "Class Notes." (Incidentally, there 
are not enough of these letters; please 
expand this section.) However, I read 
the current issue from cover to cover. I 
particularly enjoyed the articles "Strik- 
ing a Balance," "Second Wind," "When 
HMS Went to War," and "On the 
Brink." Also useful were "Bookmark" 
and "Bookshelf." 

JOHN W. PARKER '57 
PASADENA, CALIFORNIA 

Teaching the Teacher 

The quality of the Bulletin is better than 
ever. I teach medical students and I like 
to keep back issues as handy references. 
I have come to depend on the Bulletin for 



my medical education, just as I do the 
New England Journal of Medicine. 

BRY BENJAMIN '47 
NEW YORK, NEW YORK 

No Easy Answers 

I devoured the summer issue of the 
Bulletin in expectation of finding the key 
to equanimity in the modern practice of 
medicine. I was disappointed. What I 
learned was that the physician reporters 
and subjects of the articles found suste- 
nance by caring for the unfortunate, by 
engaging in other volunteer activities, 
and through developing personal hobbies 
or new callings. There was a unifying 
declaration that medicine's fundamental 
values include "a one-to-one relation- 
ship made possible only by the invest- 
ment of time." Since my retirement, 
much of my volunteer caregiving has 
been to provide time to my friends, time 
needed to clarify the inadequacies and 
uncertainties that were the conse- 
quences of hurried patient care. 

Before my retirement, the cash flow 
generated by my office-based partner- 
ship practice of internal medicine grad- 
ually approached my overhead costs, 
and my last month in practice cost me 
$200 out of pocket. But I was an 
anachronistic physician who did not 
delegate any patient counseling, "con- 
senting," or examining to subordinates 
or phone services. I provided a full hour 
for a complete history and physical 
examination, and debriefed during a 




WINTER 200 



I ^ r^ 1 J. Vj n w 



I SECOND OPINIONS FROM OUR READERS 



follow-up office visit. I knew my patients 
and they knew me. Lifeguard HMO 
labeled me an "expensive provider." 
Since my retirement, sidewalk encoun- 
ters wdth patients have reaffirmed the 
values that I provided. 

The stories contained in the Bulletin do 
not address the fundamental disconnect 
between personal care and managed care. 
I beheve that medicine's fundamental 
value does include "a one-to-one relation- 
ship made possible only by the invest- 
ment of time." The current contraction of 
financial support of a physician's time is 
sucking the quahty from medical care. 
Being thorough is no longer an option. 
Providing full information and counsel- 
ing in the selection of treatment goals for 
care in terminal illness has withered. 

I hope a future issue of the Bulletin 
will explore the ways "physician renew- 
al" can be applied in the context of med- 
icine's fundamental value: "a one-to-one 
relationship made possible only by the 
investment of time." 

ALAN F. CARPENTER '55 
LOS ALTOS, CALIFORNIA 

Keep 'Em Flying 

Congratulations on the best issue yet! 
When I read the summer issue, it was 



great to see my 1946 instructor, Arthur 
Pier '39, in his twenties — ^but where 
were his white sneakers? 

I was in London a few months ago for 
the 60th celebration of the Battle of 
Britain and, as usual, I was amazed at 
the politeness at the RAF Club in Pic- 
cadilly. No one made the faintest refer- 
ence to the 27 long, miserable months 
during which England was being 
destroyed and the United States chose 
not to come to its rescue. 

I am reminded of the line in "America 
the Beautiful": "God mend thine every 
flaw." We were very flawed but we are 
doing better now. 

JOHN W. KELLER '49 

(FORMER MEMBER OF THE ROYAL AIR 
force; RECIPIENT OF THE DISTIN- 
GUISHED FLYING CROSS) 
NAHANT, MASSACHUSETTS 

A Search for Common Ground 

The well-written (as always) letter from 
WUliam Carey '54 in your summer issue 
carried an intriguing double message 
not immediately apparent. I have never 
met with Dr. Carey, but we have corre- 
sponded over the years when his letters 
to the New England Journal of Medicine and 
Pediatrics caught my eye. 




What I read in his letter on attention 
deficient hyperactivity disorder is the 
difference between pediatricians and 
child psychiatrists in their approaches to 
patients and their illnesses. When I was 
training at Children's Hospital under 
Bronson Crothers, he wrote about this, 
and he gave me the impetus to turn from 
my pediatric training and, much later, to 
become a child psychiatrist. I retained 
my base in the Academy of Pediatrics and 
was an original member of its section on 
growth and development, so I can speak 
from both sides of the issue. 

But ADHD has baffled aU of us, and Dr. 
Carey writes meaningfully about the 
effect that this has had on clinical prac- 
tices with children. His letter illustrates 
well the difficulty of any two practitioners 
talking calmly about the relation between 
diagnosis and therapy with these famiffes 
and their offspring. Although he wisely 
exhorts us to use optimism, it is also clear 
that the issue, first raised by Charles 
Bradley in 1938, suggests that we indeed 
"have a long way to go." Unfortunately, the 
pediatricians think the psychiatrists lack 
optimism, and the latter group think that 
the former's optimism is blind. Perhaps 
consensus is a will-o'-the-wisp when 
technical thinking meets inherent philoso- 
phies of caregiving. 

On another subject, when you write 
your next installment on HMS going to 
war, please remember that there were 
many of us congregated elsewhere. The 
23rd (Buffalo) General included more 
than a half dozen from HMS in its roster. 
By the time it set up in Vittel, France, it 
had already seen battle action in Naples 
(where, incidentally, an HMS Medical 
Society met monthly). In France it grew 
to 3,000 beds with a similar 1,000-bed 
rehab unit. We were fortunate to be in 
former hotels during the extremely cold 
winter of 1944-45, but we were flooded 
with patients when the Battle of the 
Bulge arrived. Our experiences were 
shared by our neighbors, the 5th and 6th 
General Hospitals. 

HENRY H. WORK '3/ 
BETHESDA, MARYLAND 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 




IN MEMORY OF CHARLES DAVIDSON 

December 7, 1910-March 15, 2000 

"With your 'ho, ho' manner and 
thundering laugh, some passed 
you off as just a jovial 'good 
old boy' who happened to 
study the liver. But v^e knew 
better. We knew that your 
sharp glance didn't miss a thing. 



Remembering a Titan 

Following publication of a memorial to Charles 
Davidson in the summer issue, the Bulletin 
received the text of a eulogy delivered by Steven 
Schrocder '64 at a memorial service for David- 
son at Harvard's Memorial Church on June I, 
2000. Schroeder interned on the U and IV (Har- 
vard) Medical Services of Boston City Hospital 
from 1964 to 1966 and from 1968 to 1969 He is 
currently president and chief executive officer of 
The Robert Wood Johnson Foundation. 

It didn't have to be that way, and it puz- 
zled a lot of people. The hospital was old 
and in poor repair. It smeUed bad. Its civil 
service staff were underpaid, and many of 
them had lost their sense of customer ser- 
vice, if they ever had it to begin with. Cru- 
cial supphes were too often scarce or 
missing. And far too many patients were 
tragically self-destructive, to the despair 
of those who had to care for them. 

Yet, despite all those obstacles, the 
morale among interns, residents, and fel- 
lows of the Harvard Medical Service of 
Boston City Hospital was the best of the 
best teaching hospitals, at least that is 
what those of us thought who were privi- 
leged to ser\'e there. 

How did this happen? What drew 
accomphshed young doctors to this run- 
down hospital in a shabby part of town? 
What made them have such pride in 



—STEVEN A. SCHROEDER 



working so hard as well as such dread of 
letting down their peers? 

It has been said that leadership is 
cause, and all else is effect. If that is so, 
then the roots of the successful Harvard 
medical training programs lay in the rul- 
ing triumvirate of William Castle '21, 
Maxwell Finland '26, and Charles David- 
son. Of the three. Castle and Finland 
were better known nationally. Indeed, 
they dominated their fields of hematol- 
ogy and infectious diseases. 

But to those of us working in the trench- 
es of the Peabody and Medical buildings — 
as well as the Thorndike Laboratory — it 
was Charlie Davidson who set the tone. Oh, 
you were a sly one, Charhe! With your "ho, 
ho" manner and thundering laugh, some 
passed you off as just a jovial "good old boy" 
who happened to study the hver. But we 
knew better. We knew that your sharp 
glance didn't miss a thing. We noticed that 
you never played favorites, even though 
there were colleagues among us who 
deserved special praise. We noticed that 
you never stinted in demanding the very 
best for our patients, no matter how poor 
or disenfranchised they seemed. And you 
always insisted they be treated with digni- 
ty, whatever their circumstances. 

We also grew to admire your wisdom in 
choosing which battles to fight, and which 
to avoid. There was a limit to how much 
you could push the city bureaucracy to 



yield more resources and better serxdces for 
patient care, and you must have quickly 
realized those constraints. Yet there 
seemed to be no limit to what you would 
do to make sure we had every opportunity 
to take the next steps in our young careers. 

I don't think we realized how much 
personal care and guidance we got from 
you at that time, nor how much you had 
nurtured the spirit and soul of the resi- 
dency program. It was only later, when we 
compared experiences with graduates of 
other programs, that we realized just how 
fortunate we had been. 

So maybe that is why — a quarter centu- 
ry after the Harvard Medical Service was 
disbanded in 1973 — scores of your former 
residents and feUows gathered with you 
on Cape Cod to celebrate the bonds they 
had forged together and to acknowledge 
just how much you had given them. To be 
sure, nostalgia had put a Camelot-Kke halo 
on what had been a gritty experience at 
the time. Yet, there was no denying the col- 
lective pride in what we had endured 
together, as well as in the subsequent 
accomphshments of our coUeagues. 

But now aU three of you are gone, first 
Max, then Bill, and now you, Charffe. We 
are gathered here today in gratitude for 
the legacy that you left us, which will 
endure for the rest of our professional Hves 
and — ^who knows — maybe even beyond. 
For you inspired us to do our best, to 
respect the less fortunate among us, and 
to trust and nurture our colleagues. No 
one could have given us a better start in 
medicine than the one you gave us. The 
fact that so many of us are here today — in 
body or in spirit — is a tribute to that lega- 
cy and testimony that we will continue to 
strive to deserve your pride and support. 

May you rest in peace. 

STEVEN A. SCHROEDER '64 
PRINCETON, NEW JERSEY 

The BuUetin welcomes letters to the editor Please 
send letters by mail (Harvard Medical Alumni 
Bulletin, 25 Shattuck Street, Boston, Massa- 
chusetts 02115): fax (617-432-0013); or email 
(bulletin@hms.harvard.edu). Letters may he 
edited for length or clarity. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



ptit.se 



MAKING THE ROUNDS AT HMS 




On the Cutting Edge 



HIS FALL, ALUMNI FROM THE 

Classes of 1931 through 2000 
attended the first-ever semi- 
nar intended for all alumni. 
"HMS at the Millennium: What's New 
and What's Happening In and Around 
the Quadrangle" was moderated by Ten- 
ley Albright '61, chair of the Alumni 
Fund, and Daniel Federman '53, senior 
dean for alumni relations and clinical 
teaching. The two-day program, held on 
the HMS campus, aimed to update alum- 
ni on new events, institutes, depart- 
ments, and medical frontiers at HMS. 

The program began with a welcome by 
Alumni Council President Charles Hatem 
'66. After a message from Dean Joseph 
Martin, the presentations got under way 
with a lively talk, by Judah Folkman '57, 
Andrus Professor of Pediatric Surgery. 
Folkman, who proposed the concept of 
angiogenic disease and reported the first 
angiogenesis inhibitor, has opened a field 
of investigation now being pursued 
worldwide. He discussed angiogenesis 
inhibitors in clinical trials for cancer in 
the United States and Europe. 

In the next presentation, Stephen 
Goldfinger, faculty dean for continuing 
education, noted that continuing medical 



education at Harvard began in the 1870s 
at the request of alumni. Each year, he 
said, the program at Harvard has approx- 
imately 40,000 enroUees, 70 percent of 
whom are physicians. Participants come 
from all 50 states and 67 foreign coun- 
tries. Approximately 180 one- to five-day 
courses are offered each year, in addition 
to home study modules, conferences, and 
programs on topics ranging from stem 
cell transplants to the relationship 
between spirituality and healing. "The 
holy graH of continuing medical education 
is being able to measure the success of 
programs in terms of the health of those 
we care for," Goldfinger said. 

Benjamin Bierbaum, chairman of the 
New England Baptist Bone and Joint 
Institute, covered new advances in joint 
replacement surgery. He discussed excit- 
ing developments in basic science, gene 
research, biomechanics, and biomaterials 
that have allowed physicians to refine 
the art of reconstructing joints, helping 
patients to resume activities that enrich 
their hves. Bierbaum also discussed new 
educational tools that are assisting physi- 
cians in training a new generation of ortho- 
pedists to fulfill the needs of the elderly, 
whose numbers are rapidly increasing. 

Phfhp Leder '60 then discussed how, in 
20 years, the Department of Genetics at 



HMS grew from three principal investiga- 
tors to twenty-nine. Leder updated alumni 
on genetics and genomics, touching on such 
subjects as informatics, stem cell research, 
gene therapy, and mouse models of human 
disease. He also afforded a glimpse into the 
future, considering pharmacogenetics, 
complex genetic diseases, and developmen- 
tal and behavioral genetics. 

The Friday program concluded wdth 
participants — including current HMS stu- 
dents — gathering at VanderbUt Hall for a 
reception with Nobel Laureate Joseph 
Murray '43. Many then went on to attend a 
special program that evening, "Reverence 
for Life: A Celebration of Service," in 
commemoration of the 125th anniversary 
of Albert Schweitzer's birth and the 
250th anniversary of Joharm Sebastian 
Bach's death. The program, organized by 
B. Lachlan Eorrow '83, included a concert 
featuring the Longwood Symphony 
Orchestra Chamber Music Ensemble and 
reflections on Schweitzer's legacy and 
community service. 

Seminar participants recom'ened on 
Saturday morning for a panel called "Meet 
the Experts." The experts included 
Charles Hatem; Jeffrey Drazen '72, editor- 
in-chief of the New England ]oumal ofMcdi- 
cinc; Dennis Kasper, executive dean for 
academic programs at HMS; Michael 




SEMINAR LEADERS: 
Speakers at the alumni 
event included: 

A. Stephen Goldfinger 

B. Eleanor Shore '55 

C. Benjamin Bierbaum 

D. Marian Neutra 

E. Philip Leder '60 

F. Gerald Foster '5 1 
G. Peter Black 

H. Judoh Folkman '57 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 




BACK TO SCHOOL: Seminar organizer 
Tenley Albright '61, v\^ith participant 
Andy Roddenbery '42 



Laposata, director of clinical laboratories 
at Massachusetts General Hospital; and 
Judith Messerle, Hbrarian of the Count- 
way Library of Medicine. 

The Saturday program continued 
with a talk by Gerald Foster '51, former 
associate dean for admissions, who dis- 
cussed HMS students of yesterday, 
today, and tomorrow. He presented indi- 
vidual profiles to show the range of 
backgrounds among HMS students, and 
compared the students of the Class of 
1951, most of whom were white men, 
with those of the Class of 2000, 54 
percent of whom were women and 44 
percent of whom were people of color. 

"At HMS, there is diversity not only of 
gender and ethnicity, but also in back- 
grounds, interests, and accomplishments," 
Foster said. "We are all enriched by the 
talents and diversity of our students." 

Peter Black, chairman of the Depart- 
ment of Neurosurgery at Brigham and 
Women's Hospital, then gave alumni a 
look at an operating room of the future. 
He discussed his work, which empha- 
sizes cutting- edge 3-D technology for 
resecting tumors. Through collabora- 
tion with the Surgical Planning Labora- 
tory, Black helped develop the Brigham 
Surgical Navigator and the revolution- 
ary intraoperative MRL He presented 
slides and video footage showing how 
such imaging techniques are used to 
remove brain tumors, and discussed 
surgeons' ability to do brain mapping. 
These techniques, he said, give surgeons 
"MRI vision" in dealing with subtle 
brain abnormalities. 

Eleanor Shore '55, HMS dean for facul- 
ty affairs, highlighted the accomplish- 
ments of the HMS Center of Excellence 



in Women's Health, which has estab- 
lished a fund to confer grants for interin- 
stitutional projects focusing on women's 
health issues. The center has also suc- 
ceeded in having women's health desig- 
nated as a tenth curricular theme in med- 
ical student education, conducted a fac- 
ulty salary gender equity study, and 
sponsored conferences. In addition, it has 
supported the expansion of the 50th 
Anniversary Program for Scholars in 
Medicine, designed to assist young physi- 
cians and scientists in pursuing an aca- 
demic career. Thus far the program has 
awarded 100 fellowships of $25,000 each. 

Shore concluded her talk by citing sta- 
tistics from a Commonwealth Fund study 
of men's health. "Men's life expectancy at 
birth is still shorter than women's by six 
years," she noted, "which suggests that 
HMS may need a Center of Excellence in 
Men's Health as well." 

Marian Neutra, professor of pediatrics 
and director of the GI Cell Biology 
Research Laboratory at Children's Hospi- 
tal, gave the closing presentation, on the 
uptake of antigens, pathogens, and vac- 
cines at mucosal surfaces and local 
immune protection. She discussed recent 
research, including studies in which 
uptake of antigens and vaccines by spe- 
cialized epithehal M cells has been corre- 
lated with the resulting secretory 
immune responses on local mucosal sur- 
faces. Such research, she said, promises to 
play an important role in the develop- 
ment of new strategies for preventive 
childhood and adult vaccines against 
pathogenic viruses and bacteria that col- 
onize or invade mucosal surfaces. 

Seminar organizer Tenley Albright 
described the event as a great success. 
"Top people in a number of different 
departments and specialties spoke about 
the latest advances, not just in one field, 
but across the whole scope of the Med- 
ical School," she noted. "It made us reahze 
just how much medicine is evolving all 
the time, especially at HMS." The semi- 
nar's organizers hope that it will help 
create a channel for the flow of informa- 
tion between HMS and its alumni. ■ 



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WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



PTIT.SF 



I MAKING THE ROUNDS AT HMS 



Class Act 




port the 
School's 



ARVARD MEDICAL SCHOOL IS 

creating a multi-million 
endowment to hind the Acad- 
emy at HMS, which will sup- 
educational activities of the 
most gifted and innovative 
teachers. The Academy initiative is the 
brainchild of Daniel Lowenstein '83, dean 
for medical education at HMS. The goal, 
he says, is to promote, model, and reward 
excellence in medical teaching. 

Students, Academy members, non- 
Academy faculty, and the broader 
national community of medical educa- 
tors all stand to benefit in different ways 
from the School's renewed commitment 
to outstanding teaching in the face of 
rival demands on medical faculty time 
and energy. In recent years, the rigorous 
demand for research in academia and the 
advent of managed care have put the 
medical school structure to the test; 



doctors, hard-pressed to be more effi- 
cient and see more patients, have less 
time to devote to students. "Our goal is 
to correct a structural limit in medical 
schools that prevents the optimal sup- 
port of their teaching mission," Lowen- 
stein says. 

At HMS, the new Academy is intended 
to enhance and support teaching above 
and beyond what currently exists at the 
School and its teaching hospitals. Initial 
membership vdll be Limited to between 75 
and 100 faculty of assistant professor rank 
or higher, and will be expanded over time. 
Membership will be representative of all 
major areas of the curriculum, and, to the 
greatest extent possible, of all Quadrangle 
departments and chnical departments at 
the affihated teaching hospitals. 

Entry into the Academy vvdll serve as a 
reward for those faculty who demonstrate 
superior achievement and leadership in at 
least three out of five areas: teaching skills, 
curriculum development, course or educa- 
tional program directorship, national 



scholarship related to education, and 
mentoring. The ideal member, Lowenstein 
says, will possess "a passion for teaching, a 
willingness to commit time to teaching, 
and a reputation as an innovator or role 
model educator." Fellows wlU consist of 
students, residents, junior faculty, and 
others who wish to advance their skills as 
teachers under the mentorship of a regu- 
lar member of the Academy. 

The endowment is being funded by 
contributions from both public and 
private sources. Funding will support 
grants to faculty members as well as 
the establishment of "Academy-owned" 
endowed chairs. Individual donors wiU 
have the opportunity to support profes- 
sorships named after them, and entire 
alumni classes may choose to create pro- 
fessorships named after the class itself or 
a beloved teacher. "The biggest effect of 
the Academy," Lowenstein says, "will be 
to support a critical mass of gifted teach- 
ers in their efforts to advance the quahty 
of education at HMS." ■ 




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HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



PRESTDENT\S REPORT 





HE FALL MEETING OF THE ALUMNI 

Council, held October 19 and 
20, segued into a Harvard 
Medicine at the Millennium 
event, "What's New and What's Happen- 
ing In and Around the Quadrangle." This 
seminar, moderated by Dan Federman '53 
and Tenley Albright '61, featured a message 
by Dean Joseph Martin about the state of 
the School and presentations on subjects 
that ranged from computational genetics 
to advanced technology in neurosurgery. 

At the Council's dinner, new members 
were introduced: Mitchell Rabkin '55, 
president-elect; Pete Coggins '58, treasur- 
er; Rafael Campo '92, 2nd Pentad; Kathryn 
ZufaU-Larson '75, 5th Pentad; and Francis 
Wood '54, 9th and Beyond Pentads. 
Reports included updates from the Bulletin 
by WiUiam Bennett '68 and Paula Byron, 
as well as from the Alumni Fund by Tenley 
Albright and Kristen White. 

The subsequent fuU-day Council ses- 
sion began with a focus on two basic ques- 
tions; Where did we come from, and where 
are we going? 

As a matter of historical record — with 
details thanks to Nora Nercessian, assis- 
tant dean for alumni affairs and special 
projects, as well as author of In Celebration 
of Life: A Centennial Account of the Harvard 
Medical Alumni Association, 1891-1991 — ^we 
acknowledged the pivotal role of James 
Chadwick, Class of 1871, in the establish- 
ment of the Harvard Medical Alumni 
Association (HMAA). His organizing 
energy assembled this "meeting of gen- 
tlemen" who voted unanimously to 
estabhsh the HMAA. The articles of the 
HMAA Constitution, quickly ratified, 
spoke clearly of the Association's goals: 
"to advance the cause of medical educa- 
tion, to promote the interests and 
increase the usefulness of the Harvard 
Medical School, and to promote acquain- 
tance and good fellowship among the 
members of the Association." 

We are advantaged by standing on 
Chadwick's shoulders, buttressed by the 
example of his commitment to HMS and 
reminded of his leadership in defining 
the mission of the HMAA. Ohver Wen- 



dell Holmes called Chadwick "the untir- 
ing, imperturbable, tenacious, irrepress- 
ible, all-subduing agitator, who gave no 
sleep to his eyes, no slumber to his eye- 
lids, until he had gained his ends, who 
neither rested nor let others rest until the 
success of his project was assured," all 
the time maintaining the temperament of 
"a poet and artist" — a rather modest 
example for us to follow! 

On the matter of future directions, the 
Council returned to an ongoing discus- 
sion about surveying the alumini. Given 
the impediments associated with any 
lengthy survey instrument. Council mem- 
bers agreed that the Internet ought to be 
pursued as a central means of obtaining 
basic information and soHciting alumni 
opinion (with supplemental written 
inquiries for those not electronically con- 
nected). Plans are accordingly under way 
for our first email survey venture. 

The Council also continued its discus- 
sion of holding one meeting a year out- 
side Boston. Last year's meeting, which 
had an excellent program yet a modest 
attendance, suggested that future away 
programs should be designed to attract 
larger numbers of local alumni. 

Jules Dienstag, faculty associate dean 
for admissions, then presented the cur- 
rent demographics of U.S. medical 
school aspirants. There remains a sus- 
tained interest among highly capable 
students in applying to HMS. 

Lastly, Dan Lowenstein '83, dean for 
medical education, offered his vision of 
estabhshing an academy at HMS designed 
to recognize and support committed 
teaching faculty in their roles as teachers, 
mentors, and developers of innovative 
approaches in medical education. 

As always, your views about the work 
of the Council are most welcome. Easy 
contact can be made with Dan Federman, 
Nora Nercessian, or me through the 
alumni office (617-432-1560) or by email: 
hmsalum@hms.harvard.edu. ■ 

Charles]. Hatem '66 is director of medical edu- 
cation at Mount Auburn Hospital in Cambridge, 
Massachusetts. 




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WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



ROOKMARK 



REVIEWING THE PRINTED WORD 



10 




30 Secrets of the World's 
Hea thiest Cuisines 

by Steven Jonas '62 and Sandra Gordon 
QohnWHey& Sons, 2000) 

UTRITION COURSES AT HARVARD MEDICAL SCHOOL 

used to be strictly elective. Most of us couldn't 
be bothered. We were studying the medicine of 
nuclear war or the art of psychiatric filmmak- 
ing. Nutrition was about confusing, interchangeable 
B'vitamin derivatives, and maybe something about starch. 
It wasn't about health. 

Personally, this attitude carried me a long way through 
training. The only pleasure of internship was a full-length 
white coat with pockets big enough for ophthalmoscope, 
EKG calipers, tuning fork, red-top tubes, purple-top tubes, 
and fistfuls of candy bars from the all-welcoming, all-vvdse 
ladies in the gift shop. Half-length student coats had less 
room for pockets, which created a terrible space 
dilemma. Medical instruments were 
necessary for treatment, but candy 
bars were necessary for life. 

Those unenlightened days are dead 
Now nutrition is as important as 
anatomy, and it is pathophysiology. In 
30 Secrets of the World's Healthiest Cuisines, 
Steven Jonas '62 and Sandra Gordon 
remind us upfront that a third of all 
North American cancer deaths are diet- 
related, and that our food directly affects 
our arteries, islet cells, and endangered 
bones. The "secret" in the title — to spiU it ^ jo.^o*- ^ 

from the start — is a "global diet" that iso- ^*'' 
lates and imports the healthiest eating habits 
from other countries. The writers have assembled these parts 
into a kind of benign nutritional Frankenstein, using this 
country's red wine, that one's vegetarianism, and plenty of 
soy for binding. 

Certainly, it is a useful idea. If each country has its own 

food pyramid, why not create a multicultural polygon? The 

book provides the details. A traditional Mediterranean diet, 

for instance, is monounsaturated, with extra-mgin ohve oil 

fuU of \'itamin E, and herbs fuU of antioxidants. (Legend has 

it, the authors write, that Greeks drank a cupful of oil each 

day before heading into the fields. This is not a cuisine sug- 

2 gestion.) China is plant-full and dairy-free (although rates of 

I osteoporosis are lower than in North America). The French 

fi paradoxes are famous — pate and low coronary artery disease, 

o thanks to wine that increases high-density hpoprotein pro- 

i duction; cigarettes and lower cancer rates, thanks to polyphe- 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 




r/n«' ^-^ 



nols that block carcinogen formation. In Japan, there is, in a 
word, fish. And, in another word, soy. Fish and soy offer 
omega-3 fatty acids and estrogen- esque isoflavones, which 
help Japan enjoy the highest life expectancy rates in the 
world. Scandinavia is high-fiber. West Africa is fiery, full of 
spices that release endorphins. The dietary pyramid of the 
future comes from such building blocks. 

Of course, these are the ethnically ideal ways of eating. 
Poor American habits — the intern's diet — have infiltrated 
international cuisine like an oil shck. In today's urban 
Greece, 50 percent of calories are from partially hydrogenat- 
ed fats. In Hong Kong, heart disease and strokes are rising in 
direct proportion to the quantity of Western restaurants. 
The enemy is us. 

30 Secrets of the World's Healthiest Cuisines promises not only 30 
secrets (keeping count is actually a httle confusing) but asso- 
ciated wisdoms as well. The epidemiologic data is mostly 
farruhar, but some of the particulars wiU stop you dead with 
interest: a couple of paragraphs on how sumo wrestlers get so 
fat; a description of the 100-pound yams 
that grow in Gambia; a guide to ordering 
different teas in a Chinese restaurant 
(rub one finger under your nose for jas- 
mine, cup your hands into petals for 
chrysanthemum, and tug your right ear- 
lobe for black) — useful signs for the busy 
reader with an empty pot. 

Throughout the book, there are "notes 
from Dr. Jonas." These are highhghted side- 
bars meant to enlighten and interest, 
although, unfortunately, not a single sumo 
wrestler crouches anywhere nearby. Little 
here is new: "Work in a workout." "Get 
more calcium." "Watch out for MSG." "Protect 
your eyesight." It is as if someone in a white coat periodically 
enters from stage left, dehvers an authoritative monologue, 
then exits under bright Hghts until the next scene. 

Any book about food should get to the heart of the matter, 
and so this one ends with 90 pages of recipes to leaf through. 
Shghtly edited, unusual, and with best wishes from Italy, here 
is one of them: 

Sorbetto di Limone e Basilico (Lemon and Basil Sorbet) 

Scrub and peel eight lemons and two oranges. Place peels in 
saucepan and add 2-1/2 cups water and 1-3/4 cups sugar. Bring to 
boil and boil rapidly for three to four minutes to reduce amount 
of liquid. Cool and strain into a bowl. Squeeze fruit, strain, and 
add juice to the syrup. Tear 24 basH leaves into small pieces and 
add. ChiU overnight. Pour into an ice cream maker and chum for 
10 to 15 minutes until sorbet is firm enough to serve. ■ 

Elissfl Ely '88 is a lecturer on psychiatry at HMS. 



Jra 



BOOKS BY OUR ALUMNI 



ROOKSHKT.F 




1 


1 111. 

111. ,Si(--|,i 
Kciict 


1 



LIFELINES 



Murid It. liillid, M.D. 



Working 
Families a 



The 

Widening 

Gap 




Who's in Charge? 

Autonomy and Mental Disorder, by John W. 
Appel '36 (Rutkdgc Books, Inc., 2000) 



The abihty to estabhsh and maintain 
independence is a critical component of 
mental health. This book presents three 
case studies that illustrate how a lack of 
identity becomes an impediment to lead- 
ing a productive life. It includes an exam- 
ination of childhood conditions that 
result in the highly dependent adult, as 
well as innovative modes of treatment 
that have been successful in restoring 
troubled patients to meaningful hves. 

Alma Farm 

An Adirondack Meeting Place, by Norman 
Francis Boas '45 and Barbara Linton 
Meyer (Boas & Meyer, Publishers, 1999) 



The authors tell the story of the Alma 
Farm, created in the late nineteenth cen- 
tury in Bolton, New York, in the foothills 
of the Adirondack Mountains. The farm 
became a meeting place for a group of vis- 
itors that included German and Ameri- 
can physicians of the time, whose families 
and descendants established a unique 
relationship vvath the community and 
each other that continues to the present. 

The 10-Step Method of Stress Relief 

Decoding the Meaning and Significance of 
Stress, by Albert Crum '57 (CRC Press, 2000) 

This book instructs readers on effective 
ways to find the causes of stress, learn its 
meaning, and interpret its messages and 
significance. The author emphasizes the 



importance of increasing — rather than 
decreasing — perception in relieving 
stress, and discusses special aids such as 
emotional literacy, natural relaxation, 
and the stress accuracy test, which can 
help readers increase perception. 

Lifelines 

Living Longer, Growing Frail, 
TakingHeart, by Muriel R. Gillick '78 
(W. W. Norton & Company 2001) 

People in the developed world are hving 
longer now than ever before, but as Me 
expectancy increases, can we look for- 
ward to enjoying those extra years? The 
author examines the period referred to as 
"frailty," when the body begins to slow 
down and multiple health problems can 
make daily functioning difficult. Focusing 
on the stories of four cases drawn from 
her clinical experience, the author high- 
hghts the challenges that arise when 
frailty develops and sheds hght on how 
people find comfort, well-being, and 
meaning in the last months or years of Me. 

The Widening Gap 

why America's Working Families Arc in 
jeopardy — and What Can Be Done About It, 
by Jody Heymann '88 (Basic Books, 2000) 



In examining the lives of working fami- 
lies in the United States, Heymann 
reaches a disturbing conclusion: there is 
a widening gap between the demands of 
the workplace and the well-being of 
American famffies. 'Who cares for our 
nation's children when decent, affordable 
child care is not widely available? What 



happens when the elderly get sick and 
need care at unanticipated times? Hey- 
mann addresses these questions by com- 
bining personal stories of the struggles of 
individual famiffes with the first system- 
atic national research on how family 
obhgations affect working Americans. 

The Washington Trap 

by G. Turner Howard, Jr. '37 
(Vantage Press, 2000) 



Howard's novel tells the story of Con- 
gressman Tom Ogden, a Tennessee native 
who brings his patriotic and conserva- 
tive values to Washington and gradually 
earns the respect of his colleagues. Along 
the way, Ogden has many adventures: he 
faces danger while investigating drug 
cartels in South America and finds 
romance in northern Italy. 

Marriage in Motion 

The Natural Ehh and Flow of Lasting Relation- 
ships, by Richard S. Schwartz '74 and 
Jacqueline Olds (Perseus Publishing, 2000) 

Harvard psychiatrists who are married to 
each other, the authors demonstrate how 
to read the natural rhythms of long-term 
relationships and navigate high and low 
points over the course of a marriage. They 
describe what a lasting relationship looks 
hke over time and how it diEers from some 
of our most deeply held beUefs about love. 
The book also explains how to develop a 
"distance alarm" that signals when a rela- 
tionship may be in danger and shows 
readers how to foster a renewed sense of 
excitement through shared experience. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



R F N C H M A R K S 



I DISCOVERY AT HMS 



Doctor's Orders: Dream a Little Dream for Me 




TEAM OF HMS SCIENTISTS HAS 

achieved what researchers 
since Freud's day thought 
nearly impossible; a way to 
control — at least in part — the content of 
a person's dreams. The investigators are 
using their dream-provoking method to 
explore age-old questions such as; Where 
do dreams come from? What do they 
mean? What is their role in memory, 
learning, and creativity? What is their 
hnk to the unconscious? 

For years, scientists have been stymied 
in their quest to understand these associ- 
ations because dreams are unique events 
that cannot be replicated. Yet HMS 
researchers reported in the October 13 
issue of Science that they were able to get 
17 different people to see the same dream 
images as they drifted off to sleep. 



"Here we have a case where with high 
reliability we can get people to have pre- 
dictable dreams," says Robert Stickgold, 
the study's lead author and an HMS 
assistant professor of psychiatry at the 
Massachusetts Mental Health Center. 

He and his colleagues elicited the car- 
bon-copy images using the computer game 
Tetris. Over the course of three days, they 
trained 27 subjects — 12 novices, 10 experts, 
and 5 amnesics — to play the game, which 
involves assembhng geometric puzzle 
pieces. The researchers then monitored the 
subjects' dreams as they were drifting to 
sleep on the first two evenings. 

Team Dream 



Seventeen of the subjects — more than 60 
percent — reported dreaming at least once 




IN YOUR DREAMS: "I look at sleep in order to understand the waking mind," 
says Robert Stickgold. "You have to look at other states of consciousness to 
understand the one that v/e take for granted." 



in the hour after they fell asleep. All report- 
ed the same dream images — faUing Tetris 
pieces. Intriguingly the majority of dream 
reports occurred on the second rather than 
the first night of training. 

This lag betvv'een the initial training and 
the most intensive dreaming is interesting 
for the hght it may shed on the link 
between dreams and learning. It appears 
that the need to learn may actually prod the 
brain to dream. "It's as if the brain needs 
more time or more play before it decides, 
'Okay, this is something that I need to deal 
uTth at sleep onset,'" Stickgold says. 

This notion — that dreaming is prompt- 
ed by a need to learn — is supported 
by other findings. The researchers found 
that novices who reported dreaming 
about faUing Tetris pieces did not per- 
form as well in their initial two-hour 
Tetris training session as those who did 
not see the images. "It's as if the more 
work you have to do, the more likely you 
are to get the imagery," says Stickgold. 

Those who needed to do the least 
work were the experts in the study, each 
of whom had previously logged at least 
50 — and sometimes as many as 500 — 
hours of Tetris playing, mostly on Nin- 
tendo sets. Half of them reported dreams 
of Tetris pieces falling before their eyes, 
but the last two experts reported an 
intriguing twist. Rather than seeing the 
Tetris pieces in black and white as they 
appeared in the experimental protocol, 
they saw them as they appeared in their 
earlier Nintendo Tetris-playing days — in 
color and accompanied by music. 

This substitution of old images for 
new ones strikes at the most distinctive 
quality of dreams — their often astound- 
ing creativity. In dreaming, the brain does 
not merely replay memories, but trans- 
forms them by associating them with old 
images and memories. 

In this regard, the findings could help 
bolster one of Freud's main propositions, 
that dreams have meaning — that they 
represent the brain's attempt to make 
sense of what happens by associating 
new events with those in the past. "But 
the experts' dreams ha\'e got none of the 
trappings, none of the freight that goes 



12 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



THE SLEEP PUZZLE 



along with the concept of a Freudian 
dream," Stickgold says. "These are not 
about wish halfillment, things they're not 
wilhng to face up to in their waking Uves. 
This isrit about their mothers, God for- 
bid. They're about this stupid computer 
game. The brain is using those same algo- 
rithms that Freud probably correctly 
saw — ^which is, take recent events and 
look for associated memories, strongly 
associated in this case, and replay them." 

Unconscious Memories 



Perhaps the most surprising findings of 
all came from the amnesics in the study. 
Co-author David Roddenberry, an under- 
graduate at Harvard University, found 
that when the five amnesics — ^who had no 
short-term memory due to hippocampal 
damage — ^were exposed to the computer 
game protocol, three of them experienced 
the same dreams as normal subjects. 

"I was just stunned when David 
called me and said they're getting the 
same dreams," Stickgold says. Although 
amnesics were known to dream, their 
dreams were thought to have little to 
do with the day's events, since those 
events are not remembered. Stickgold 



Subjects in Robert Stickgold's study 

dreamt about falling puzzle pieces after 

playing the computer game Tetris. 

JJJ 




had assumed that this would be especial- 
ly true of the early, or "hypnagogic," stages 
of dreaming explored in their studies. 
Compared to later stages of dreaming, 
such as those occurring during deep sleep 
or REM sleep, hypnagogic dreams were 
thought to be more tightly hnked to con- 
scious, or episodic, memory. "We thought 
if there's one part of sleep that depends on 
episodic memories, which amnesics lack, 
it's sleep onset," he says. 

The fact that some of the amnesics saw 
the faUing Tetris pieces points to the pow- 
erful role played by the unconscious in 
dreams. In fact, Stickgold beUeves that 
the amnesics' unconscious Tetris memo- 



ries may have affected not only their 
dreams but also their waking behavior. 
Unlike the normal subjects in their 
study — ^who improved in their Tetris play- 
ing over the course of the three days — the 
amnesics showed marginal improvement. 
Most had to be taught the game aU over 
again each day. But Roddenberry observed 
that at the start of a session, one of the 
amnesics placed her fingers on the exact 
three keys used in playing Tetris. 

"She did not quite know what she was 
doing and yet she did know what she was 
doing," says Stickgold. "In a way, this is 
Freud's unconscious — things activated in 
our brain that are, in fact, memories that 
guide our behavior but are not conscious." 

"What we're really looking at here is 
the age-old mind-body problem; the 
mind-brain cormection," Stickgold says. 
"We think of our mind as being ours. But 
there are real ways in which the brain has a 
set of rules of its own. We're getting an idea 
of what the brain uses as its noles for pick- 
ing out cortical memory traces to reactivate 
and bring into our conscious mind, and 
we're trying to see across wake-sleep 
cycles how that process happens." ■ 

Misia Landau is senior sciaiccwriter for Focus. 



New Reason to Sleep On It 

When students cut back on sleep 
to finish their homework, it could 
be a self-defeating strategy. In 
another study led by Robert Stick- 
gold, HMS researchers have 
found that people who stay up 
all night after learning and prac- 
ticing a new task show little 
improvement in their perfor- 
mance. And the study suggests 
that no amount of sleep on the following two nights can make 
up for the toll taken by the initial all-nighter. The study, pub- 
lished in the December issue of Nature Neuroscience, odds 
a critical piece to a growing body of work by Stickgold and 
others showing that sleep is necessary for learning. 




To determine whether the night of sleep actually caused 
the improvement, Stickgold trained 24 subjects in the same 
visual discrimination task. Half of the subjects went to sleep 
that night while the other half were kept awake until the sec- 
ond night of the study. Both groups were allowed to sleep on 
the second and third nights. On the fourth day, both groups 
were tested on the visual discrimination task. Those who 
slept the first night identified the correct answers much more 
rapidly than they hod the first day. The other group showed 
no improvement, despite the two nights of catch-up sleep. 

"We think that getting that first night's sleep starts the 
process of memory consolidation," Stickgold soys. "It seems 
that memories normally wash out of the brain unless some 
process nails them down. My suspicion is that sleep is one 
of those things that does the nailing down." 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 









Ir'-: 



^To have a great advent 
and survive, requires goo' 
judgment. Good judgm 
comes from experience. 
Experience, of course, 
is the result of poor 
judgment. 

GEOFF TABIN 



•■ t 




Jf^y' 






A PHYSICIAN INDULGES A PASSION FOR ADVENTURE 
AND BESTOWS THE GIFT OF SIGHT IN THE HIMALAYAS 



by Beverly Ballaro 

FOR GEOFF TABIN '85, THE QUEST FOR 

great adventure — and sound judg- 
ment — has been one long and wild 
ride. At the age of 44, he has packed 
more risk, daring, and accomplish- 
ment into his resume than most 
people experience in a lifespan. An 
ophthalmic surgeon, professional 
mountain guide, expedition doctor, family man, writer, and elite 
rock chmber, he has been described by none other than Sir 
Edmund Hillary as "both incredibly determined and a little crazy." 




STAR TREKKER: Geoff Tabin (above) 
on Mount Everest's summit. Tobin (left), 
climbing the East Face of Everest. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



commanding myself, 'One slip and you are dead — concentrate!' " 



Tabin was the fourth person in the 
world to chmb the highest peaks on all 
seven continents, including Mount 
Everest in Asia and Mount Vinson in 
Antarctica (at 16,863 feet and 78 
degrees south, arguably the coldest and 
remotest place on earth). He has pio- 
neered new routes on Mount Kenya 
and trekked through the dense jungles 
of Irian Jaya, New Guinea, to scale the 
summit of Carstensz Pyramid, a 2,000- 
foot sheer rock wall that represents the 
highest point between the Andes and 
the Himalayas. He has spent time hunt- 
ing and gathering with the Mbuti Pyg- 
mies in the Ituri Forest in northeastern 
Zaire, and befriending the cannibahstic 
Dani tribespeople in Irian Jaya. On a 
dare, he helped invent the sport of 
bungee jumping. 

These endeavors represent Tabiris 
recreation. For work, he cures blind 
people. In 1995, Tabin helped establish 
the Himalayan Cataract Project with 
the ambition of eliminating preventable 
blindness in the Himalayan regions. 
Given his extraordinary determination, 
the mission seems daunting but not 
impossible. He is, after all, a man accus- 
tomed to taking big risks and beating 
formidable odds. 

Siren Song 

Tabiris thirst for adventure was born 
not atop a mountain but between 
the covers of a book. His chance en- 
counter, as a Yale freshman, with 
the Yale library's famous collection 
of mountaineering literature, which 
includes such classics as True Mountain 
Disaster Storks, quickly led to a fanatical 
four-hour-a-day reading habit, and a 
hfelong obsession with rock climbing. 
He climbed every day of his Yale career, 
including weekend forays to tackle icy 
peaks in New Hampshire, and summer 
pilgrimages to do short, hard, technical 



climbs in the American West. Tabiris 
passion grew from his conviction that 
rock climbing represents the ultimate 
athletic and psychological challenge, 
one that he exuberantly describes as 
"a combination of chess, vertical ballet, 
and gymnastics." 

Tabiris hunt — and opportunity — for 
adventure expanded when he deferred 
admission to HMS upon vanning a 
Marshall scholarship to study philoso- 
phy at Oxford for two years. He and his 
climbing partner learned how to tap 
into trust funds left over as quaint 
rehcs from the days when, as Tabin 
puts it, "it was considered the sacred 
duty of Oxford gentlemen to go out and 
civilize the world." He adds, laughing, 
"It didrit take us long to figure out that 
the more exotic the locale we proposed, 
the more funding we got." After chmb- 
rng many of the classic routes in the 
Alps, he went in search of increasingly 
big mountains in ever remoter locations 
around the globe. 

Tabin drew encouragement and 
inspiration for his exploits from a pecu- 
har circle of friends who dubbed them- 
selves the Oxford Dangerous Sports 
Club. "They never attempted anything 
even remotely sane," he recalls fondly. 
"Their idea of fun was to go visit an 
erupting volcano to try magma surfing 
in homemade asbestos suits. They par- 
ticipated in the famous running of the 
bulls in Spain by fleeing through the 
streets not on foot but on skateboards. 
Their most ambitious plan involved 
parachuting into a hon enclosure, with 
each man carrying nothing but a 
revolver containing one bullet. Some- 
how, they never managed to bring that 
attempt off." 

When one of the Dangerous Sports- 
men learned of Tabiris plan to pass 
through the jungles of New Guinea on 
the way to a cHmb, he urged Tabin to 
try his hand at vine jumping, a rite of 



passage for indigenous tribal boys of 
the region. Upon his return, Tabin 
helped engineer, with the use of stolen 
aircraft carrier docking cords, the first- 
ever Western bungee jump off the high- 
est suspension bridge in England. 
Shortly afterward Tabin himself took 
the dizzying plunge from the world's 
highest suspension bridge in Colorado. 
"Back in 1979," he says, "there was a 
popular television show called 'That's 
Incredible,' which featured different 
people doing crazy stunts. The opening 
promo showed a white-tuxedo-clad 
man attached to a giant rubber band 
leaping off a bridge — that was me." 

Where Earth Meets Sky 

Although he arrived at HMS in the 
autumn of 1980 ^^'ith the intention of 
concentrating exclusively on his goal of 
becoming a physician, Tabiris continu- 
ing passion for rock climbing nearly 
cost him his medical career — and his 
hfe. Just six weeks into his first semes- 
ter at HMS, Tabin experienced a climb- 
ing accident on an outcrop just outside 
of Boston that sent him hurtling 15 feet 
headfirst into the ground, broke his 
arm, knocked him unconscious, and 
stopped his breathing. An HMS class- 
mate, HanseU Stedman '83, saved his 
life by performing mouth-to-nose 
resuscitation and carrying him to a 
highway to flag down help. Tabin 
remained in a coma for 36 hours and 
struggled with memory and concentra- 
tion problems after his recovery. Yet, by 
his second semester, he had resumed 
rock chmbing on weekends. 

That same spring, Tabin received a 
thrilling in\dtation. He was asked to join 
an expedition that would be making a 
historic attempt to explore and ascend 
the massive East Face of Mount Ever- 
est, a task most climbing experts con- 
sidered impossible and even suicidal. 



16 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



A WALK IN THE CLOUDS: 
Geoff Tabin participated 
in the first successful 
expedition up the East 
Face of Everest, which 
had once been consid- 
ered unclimbable. 




friends die, it brings out a powerful element of denial 



18 



To complicate the decision, the HMS 
dean for students rehised to grant him 
a leave of absence. He went anyway. 
"Here was this incredible opportunity 
and I had to ask myself, honestly, if I 
would always regret turning it down, 
despite the consequences," he explains. 
"The answer was clear." 

Although he did not reach the sum- 
mit, Tabin played a key role in the suc- 
cess of the East Face expedition, a tri- 
umph made even more extraordinary 
because it was pulled off with a mini- 
mum of supplemental oxygen and no 
native porters. When he returned from 
Tibet, Tabin learned that he had been 
kicked out of HMS. He had to reapply 
and was reaccepted with the under- 
standing that he would not disappear 
again. So, when he was invited, in 1983, 
to join another Mount Everest expedi- 
tion, he despaired of getting a leave 
from medical school. Luckily, a profes- 
sor of eye surgery approached him with 
a proposal to do a research project on 
the physiology of high altitude. 

To prepare himself for the rigors of 
the expedition, Tabin immediately 
embarked on a strenuous training pro- 
gram that involved climbing rock and 
ice every weekend and turning each 
day of medical school into a condition- 
ing circuit. "I used to run the five miles 
from my Cambridge apartment to HMS 
daily," he recalls. "When I got there, I 
would traverse the wall at the Long- 
wood T-stop and then do pull-ups in 
Vanderbilt. After the run home, I would 
sprint the steps at Harvard Stadium. 
In the spring, I easily completed the 
Boston Marathon and felt ready for the 
challenge ahead." 

When he arrived at the summit of 
Mount Everest, despite the 70-mile- 
per-hour winds and sub-zero tempera- 
ture, Tabin savored the 15 minutes he 
spent alone atop what he describes as 
"the SLX-foot-by-three-foot platform of 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



ice that is the top of the world." At 
29,028 feet. Mount Everest can be 
unforgi\'ing; ascending her icy slopes 
by moonhght, Tabin says, "I kept com- 
manding myself, 'One shp and you are 
dead — concentrate!'" To commemorate 
his moment at the summit, Tabin 
brought out a pink plastic lawn flamin- 
go with an American flag tied around 
its neck, and left behind photos of his 
family and girlfriend. 

Bigger Isn't Better 

Everest remains the only mountain 
that Tabin has chosen to climb simply 
because of its sheer altitude. "I have 
always valued quality over size," he 
says. "I think it's a shame when people 
approach mountains simply wanting 
to get to the top rather than to have 
the experience of really climbing. 
Some of my best climbs have been on 
little-known peaks and rock outcrops. 
Maximizing my efforts during each 
moment, rather than reaching the top, 
is always my goal. 

"I think it's just crazy that people 
are guided up mountains," he adds. 
"Even if they stand on the summit, I 
don't think that following fixed ropes 
with mechanical ascenders from the 
base to the summit while breathing 
large amounts of bottled oxygen and 
having everything carried for them is 
actually climbing the mountain. An 
equivalent would be talking a layperson 
through performing a surgical operation 
and then having that person, after hav- 
ing tied a few knots, proclaim, 'Yeah, I 
went to medical school.' Frankly if they 
are truly in search of a good adventure, 
such people would be better off skip- 
ping Everest and taking on the risks of 
climbing Mount Washington in winter." 

Risk, Tabin explains, is "an unfortu- 
nate but essential ingredient that hap- 
pens to come along with figuring out 



how to do things." From this perspec- 
tive, he sees many parallels between 
medicine and rock climbing. Scaling tall 
mountains and performing surgery he 
explains, both require a great deal of 
time and preparation and do not lead to 
instant gratification. Both involve ele- 
ments of risk and surprise. Both 
demand absolute, total focus and Zen- 
like concentration. And both lead, 
inevitably, to the need to make and exe- 
cute decisions of larger-than-life impor- 
tance. "Just this morning, for example," 
Tabin notes, "I was doing a cataract 
operation and a part of the patient's eye 
tissue tore. I had to stop, think, and 
immediately come up with an alterna- 
tive approach, the outcome of which 
would determine whether this man 
would end up blind or able to see." 

Close Ties and Close Calls 

Now married to a fellow ophthalmolo- 
gist and father to two and stepfather 
to three, Tabin seeks to reconcile — 
and sometimes com.bine — the lure of 
the mountains with the tug of domes- 
tic responsibilities. His family is cur- 
rently hosting a young Sherpa boy in 
their home. His 13-year-old daughter 
is an avid climber, and the whole fam- 
ily enjoys the use of the indoor rock 
gym that adorns their house. 

Tabin remains as enthusiastic as ever 
about his sport and continues to 
indulge his passion for difficult climbs. 
Although he dishkes being separated 
from his children for long periods of 
time, he stiU spends about two months 
of every year in the mountains of Asia 
working on the Himalayan Cataract 
Project. Yet, he says, "I would never even 
consider attempting another ascent of 
Mount Everest. Although I stiU go out 
and run a couple of marathons every 
year, I'm simply not at the level of fitness 
that it would require. At this point in 



Your first reaction is, well, I wouldn't have done it that way.'' 



my life, it's crucial for me to maintain a 
certain margin of safety." 

Tabtn has, after aU , experienced more 
than his fair share of close calls over the 
years. He once plummeted 80 feet off a 
mountain in Colorado and ended up 
dangling upside down, his head sus- 
pended a discomforting three feet above 
a sohd rock ledge, hi Nepal, he endured 
72 hours of nonstop chmbing above 
20,000 feet, after he had gone for 24 
hours without water and nearly three 
days without food; only the luck of a fuU 
moon and perfect weather permitted 
him to survive. Retreating down Everest 
on his 1983 expedition, while hauhng 
enormous loads of gear and garbage off 
the mountain, Tabin shpped and ended 
up submerged in the snow, unable to 
breathe or move, when his heavy pack 
flipped him upside down. His life was 
saved that day by a close friend and fel- 
low climber. Some years later, this friend 
died, along with his wife, in a long tum- 
ble from an icy mountain. 

Tabin is philosophical on the topic of 
death. He has seen many of his friends 
perish in avalanches, storms, falls, and 
other adventuring mishaps, and calcu- 
lates that, but for the grace of God, he's 
come close to dying himself on half a 
dozen occasions. His book. Blind Comers: 
Adventures on Sewn Continents, swarms 
with the ghosts of dead friends with 
whom he once shared exotic adventures 
and whose memories he vibrantly resur- 
rects. "When friends die, it brings out a 
powerful element of denial," he says. 
"Your first reaction is, well, I wouldn't 
have done it that way, and so I wouldn't 
have succumbed to that same fate." 

Witnessing so much death, however, 
has also enlightened Tabin by enabling 
him to celebrate life from a perspective 
not readHy available to those who have 
not taken his risks and survived his 
losses. "I'm rarely riled by the Httle 
things in life," Tabin says with a laugh. 



"I have what many people have 
described as a truly mellow personality. 
And I believe that this is because my 
experiences — especially my losses — 
have taught me what is impossible and 
what is not, what is important and 



what is not. Most of all, they have 
taught me to really appreciate the gfft 
of being alive." ■ 

Beverly Ballaro is associate editor of the 
Harvard Medical Alumni Bulletin. 




Geoff Tabin is the co-founder of the University of Vermont Himalayan 
Cataract Project (www.cureblindness.org), a low-budget, all-volunteer 
program whose goal is to eliminate preventable and treatable blindness 
in the Himalayan regions. Whether due to a genetic predilection, the 
intense ultraviolet sunlight, the standard diet, or other factors, this region 
has one of the highest rates of curable blindness in the world. 

Cataracts are the leading cause of blindness worldwide. In Nepal, 
cataracts and failed cataract surgery cause more than 70 percent of 
the cases of blindness, and half of all Tibetans are blind from treatable 
cataracts by age 70, with many people blind by age 40. There is a huge 
backlog of people requiring cataract surgery. 

Most of the other causes of blindness in this 
area are also either treatable or preventable. 
Corneal disease from vitamin A deficiency, 
trachoma, and other infections are the primary 
blinding diseases for children. The difficult 
mountain terrain and lack of social services 
exacerbate the situation. 

Project goals include: disseminating cata- 
ract surgical skills; improving the skills of doc- 
tors now practicing ophthalmology in the 
Himalayan regions; helping the physicians 
the project trains to become self-sustaining 
through cost recovery; performing high-volume 
cataract camps in regions where no care is 
available and the population does not warrant 
training a doctor; and training fully qualified 
ophthalmologists and subspecialists to be future teachers for the region. 

The project welcomes the help of Western ophthalmologists. There 
is a minimum one-month teaching commitment in addition to at least 
a week of clinical surgery per season. 

For more information, contact: Geoff Tabin, University of Vermont Med- 
ical School, 1 South Prospect Street, Burlington, VT 05401 ; phone: 802- 
847-3843; fax: 802-847-1481; email: cureblindness@whitespider.net. 




A SIGHT FOR SORE EYES: 
After cataract surgery, a 
Tibetan >voinan sees her 
baby for the first time. 



V/INTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



19 




HEARING AID: In northern Greenland, 

neurophysiologist S. Allen Counter 

tests the hearing of Avataq Henson, 

a grandson of Matthew Henson, 

co-discoverer of the North Pole. 




DURING HIS QUEST 
TO PREVENT SEVERE 
HEARING LOSS AMONG 
INUIT HUNTERS IN 
GREENLAND, A 
NEUROPHYSIOLOGIST 
GAINS LONG-OVERDUE 
RECOGNITION FOR 
THE CO-DISCOVERER 
OF THE NORTH POLE 



THE INUIT HUNTER CROUCHES BY A HOLE IN THE ICE. 

Hidden behind a white sailcloth blind attached to 
his rifle, he maintains a silent vigil. He can hear ice 
calving off a glacier in the distance; nearby, an 
Arctic tern caws. Finally, after an hour of concen- 
trated waiting, he hears a telltale bubbhng of the 
water. Despite the loss of precious seconds, he 
fumbles beneath his anorak for small foam cones, 
which he pops into his ears before aiming his rifle 
and shooting the unsuspecting seal. 

In those few seconds, the hunter risks losing the 
seal rather than his own hearing, for he knows that if 
he doesn't, soon he won't be able to hear the water 
bubbling, or even his own child speaking. That 
knowledge — and the foam cones — came from 
S. AUen Counter, an HMS professor who has linked 
prevalent hearing loss among Inuit men in Greenland 
with the explosive noise from their guns. "These rifles 
dehver a terrific blast," Counter says, "because they 
must be powerful enough to bring down a polar bear." 

by Paula Byron 








WINTER 200' 



HARVARD MEDICAL ALUMNI BULLETIN 



21 



turn the audiometer up to 70 or 80 decibels for them to pick up 



Counter first became interested in 
the Arctic when he read reports about 
high rates of deafness among the Inuit 
of Canada. He traveled to northern 
Greenland, where, he says, "the Inuit 
have suffered some of the worst hearing 
losses in the world." In his search for 
the culprit, he was able to rule out both 
chronic ear infections and noise from 
snowmobiles, which the Danish gov- 
ernment has outlawed in northwest 
Greenland, where the Inuit still travel 
by dogsled. That left hunting rifles. 

"I would go out on the ice with the 
hunters," Counter says, "and I couldrit 
believe how severe their impairment 
was. My testing showed that they were 
losing their hearing one gunshot at a 
time. The boys begin to have problems 
at the age of ten, because that's when 



they start to hunt. Within five years, 
their loss matches that of sixty-year- 
olds in the United States." 

The hunters experience irreversible 
sensorineural hearing loss, in which 
the sensory mechanisms that commu- 
nicate with nerve fibers to deliver 
sounds to the brain are damaged. In 
such cases. Counter says, hearing aids 
offer little help, because the gunshots 
destroy the hunters' ability to per- 
ceive sounds at higher frequencies, 
where most consonants register. 

"I would turn the audiometer up to 
70 or 80 decibels for them to pick up 
what people with normal hearing 
can detect at 10 or even 5 decibels," 
Counter says. "It's very frustrating for 
them. They can hear you speaking, but 
they can't understand your words." 



Counter also found that while young 
Inuit women tend to have htde impair- 
ment, the older women often experience 
some loss at the higher frequencies. 
Although they're not the ones firing the 
guns, they too are exposed to the noise 
of the gunshot blasts when they accom- 
pany their husbands on hunting trips in 
order to butcher the seals. 

When Counter returned home, he 
appealed to an American company that 
sold ear protection de\'ices. The compa- 
ny donated a supply of specialized 
earplugs, which Counter distributed on 
his next visit to northern Greenland. 
"Many of the Inuit hunters now wear 
them," he says, "but compHance is still 
comphcated, because they don't want 
the seals to get away while they're fum- 
bling for earplugs." 




22 HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



National Geographic Society declined to give the medal to 



24 



Silent Partner 

Alerting Inuit hunters to auditory risks 
has not been Counter's only achieve- 
ment during his forays to Greenland. He 
has also helped explorer Matthew Hen- 
son gain belated recognition for the role 
he played in discovering the North 
Pole — a role, Counter says, that was 
overlooked because Henson was black. 

"Henson was among the most suc- 
cessful Arctic explorers of all time," 
Counter says, "yet he has remained rela- 
tively unknovvTi in his own country. His 
achievements were overshadowed by 
those of his white companion, Peary." 

Despite an old controversy sparked by 
Frederick Cook's claim to have reached 
the top of the world first, Robert Peary 
has been largely credited with the dis- 
covery of the North Pole. For more than 
20 years, Henson was Peary's most loyal 
and trusted traveling companion. As a 
U.S. Navy messenger — one of the highest 
ranks a black man could achieve at the 
time — Henson accompanied Peary on 
numerous Arctic expeditions, including 
the historic one to the North Pole. 

On April 6, 1909, Henson, Peary, and 
four Inuit men reached the Pole. Peary 
had chosen Henson over his five white 
assistants to accompany him on the 
final run, saying he could not make it 
without him. "During their previous 18 
years together in the Arctic, Henson and 
Peary had risked hfe and hmb together 
in more than 10,000 miles of explo- 
ration," Counter says. "Throughout their 
voyages, Henson had been invaluable to 
Peary, as dogsled driver, mechanic, navi- 
gator, translator, and friend." 

Peary was not the only one to admire 
Henson's prowess in the Arctic. The 
Inuit, who called Henson "Mahri- 
Pahluk," or "Matthew, the Kind One," 
admired his abihty to speak their lan- 
guage, drive dogsleds, hunt walruses. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



and skin seals. They also beheved that 
the Inuit who accompanied Henson and 
Peary to the Pole would not have under- 
taken such a dangerous mission had it 
not been for Henson. 

When the two explorers returned to 
the United States, the press Uonized 
Peary; the role of his "colored servant" 
was accorded footnote status. Disparities 
in the treatment of the two men contin- 
ued to the end of their Uves. Peary was 
buried with fuU honors under an impres- 
sive monument at Arlington National 
Cemetery, while Henson was laid to rest 
in a simple grave in a Bronx cemetery 

In from the Cold 



In 1986, the year of his first visit to Green- 
land, Counter petitioned President 
Ronald Reagan for permission to transfer 
Henson's remains to Arlington National 



Cemetery. In October 1987, his request 
was granted. The foUowing spring, on 
the 79th anniversary of the North Pole 
discovery, Henson and his wife, Lucy, 
were reinterred in Arlington National 
Cemetery with full mihtary honors and a 
stately monument adjacent to the one 
erected for Peary. In attendance at the 
ceremony were several of Henson's Inuit 
descendants, whose presence was anoth- 
er result of Counter's unflagging efforts. 
On his initial trip to northern Green- 
land, Counter had inquired about some- 
thing that had long intrigued him: a 
rumor that members of the North Pole 
expedition had fathered children there. 
During his first week in the Arctic, he was 
surprised to meet Anaukaq Henson, the 
80-year-old son of Matthew Henson. 
Weeks later, he met Kah Peary, the 80- 
year-old son of Robert Peary. "I learned 
that Anaukaq and KaH had both dreamt 




Henson, asking for the name of the most appropriate white man." 



of meeting their American relatives and of 
seeing their fathers' graves," Counter says. 

In 1987, Counter brought both men, 
along with 12 members of their fami- 
hes, to the United States. During their 
two-week visit, dubbed the "North 
Pole Family Reunion," each son met his 
American relatives for the first time 
and laid a wreath at his father's grave. 
"I'll probably never do anything more 
memorable in my life than bringing 
those relatives together," Counter says. 
The following year, he arranged for 
some of the Greenlandic Hensons to 
attend the reinterment ceremony. 

Counter's devotion to Hensoris mem- 
ory is still bearing fruit. This winter, the 
National Geographic Society at last 
bestowed upon Henson its most presti- 
gious honor — the Hubbard Medal. The 
society had awarded Peary its first Hub- 
bard Medal, for Arctic exploration, in 



1906, and a Special Medal of Honor for the 
discovery of the North Pole in 1909. That 
same year, the society awarded the Hub- 
bard Medal to Robert Bardett, a white 
member of Peary's expedition party who 
had not even reached the North Pole. 

"Peary admitted that Henson was 
the only other American member of the 
expedition to make it to the Pole," 
Counter says, "but the society declined 
to give the medal to Henson, asking for 
the name of the most appropriate white 
man." On November 28, 2000, the soci- 
ety posthumously presented the Hub- 
bard Medal to Henson for his contribu- 
tions to Arctic exploration and the dis- 
covery of the North Pole. 

Arctic Dreams 



Counter remains in touch with the 
Inuit descendants of both northern 





CHILDREN OF THE NORTH: 
A. Both Matthew Henson 
(pictured) and Robert 
Peary fathered sons dur- 
ing their Arctic expedi- 
tions. B. From left: Kali, 
Peary's son; S. Allen 
Counter; Anaukaq, Hen- 
son's son; and Talilon- 
quaq, Peary's grandson. 
C. The Hubbard Medal. 



explorers. A thousand miles above the 
Arctic Circle, these descendants hve as 
subsistence hunters in the world's 
northernmost communities. "The Arc- 
tic is simply a fantasy land," Counter 
says. "You can actually see icebergs 
forming when the glaciers calve, and it's 
exciting to be on the water with whales 
swimming alongside your boat. 

"What you notice most about the 
Arctic is how pristine it is," Counter 
adds. "It's a vast expanse of blue sky and 
an unending white desert of snow and 
ice. You want to run out onto that ice 
field forever; in fact, I once gave in to 
that impulse, until I realized that I was 
running on the Arctic Ocean!" 

Whenever he visits. Counter says, his 
Inuit friends are protective of him, 
because so many dangers lurk that far 
north. "On one of my visits," he says, "I 
was leaning against a dogsled trying to 
keep quiet, because a hunter was aiming 
at a seal. When the dogs tethered to the 
sled heard the shot, though, they bolted 
toward the hunter, because their first 
instinct is food. I fell backward into a 
crevasse and had to be rescued." 

Counter returns to northern Green- 
land as often as he can. "Now that 
many of the hunters are using hearing 
protection devices," he says, "I like to 
monitor any changes of status in their 
hearing." He is also hoping to help 
combat trichinosis, which the Inuit 
contract at alarming rates when they 
eat raw polar bear meat. 

"My experiences in Greenland have 
taught me the value of bringing a sense of 
humanity to medical research," Counter 
says. "After all, our ultimate aim is to bet- 
ter understand each other and to improve 
the quahty of life for the human family, 
whether black, white, or Eskimo." ■ 

Paula Byron is editor of the Harvard Medical 
Alumni Bulletin. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



, f '1 



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r&*ieftfe«ig.3 




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K^ 












r rn/tf^'"?^ " ^ * ?««■'•* - 







EXPLORING THE ARCTIC BY DOGSLED, | 
IN ALASKAN VILLAGES, AND ON 
BOARD A RUSSIAN ICEBREAKER, 
THREE PHYSICIANS DISCOVER THE 
ENCHANTMENTS OF THE FAR NORTH 

hy Paula Byron 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



orman Wilson '63 



WHEN NORMAN WILSON LEARNED ABOUT ESKIMOS AS A FIFTH 

grader, he thought, "These people are a world away, living 
in their igloos. No one could ever visit them." Nearly five 
decades later, he encountered that world, when he ven- 
tured to Baffin Bay with a physician friend in 1995. 

Wilson's odyssey began with a flight to Pangnirtung, a 
small Inuit community on Baffin Island, near the Arctic 
Circle. Since World War II, when the government relocat- 
ed them from their traditional villages, the Inuit at Pang- 
nirtung have lived in a settlement of small metal houses. 
Today, many supplement subsistence hunting with a 
monthly welfare check. Yet Wilson's first sight of the com- 
munity did not create nearly as strong an impression on 
him as did the displacement of his sense of time. In May, 
under the midnight sun, he was startled by the sounds of 
children playing outside at three in the morning. 

Wilson quickly found himself o\'erwhelmed by the 
stark beauty of the surrounding landscape. "When you 








THE FROZEN NORTH: 
A. Norman Wilson 
helps his Inuit hosts 
prepare sleds for a 
seal hunting trip in 
Baffin Bay. B. The 
dogs love to pull the 
sleds. C. A member of 
the seal hunting expe- 
dition and one of the 
dogs provide a good 
sense of scale for an 
iceberg towering 
in the background. 





% 



get out onto Arctic ice, it's almost 
otherworldly," he says. "You see 
nothing on the horizon but more 
ice, either flat or in mounds that 
are crystal clear, with a beautiful 
bluish tint, almost sapphire. The 
shadows are sharp and distinct. 
And the sun circles around you on the horizon, except for 
one brief period, when it dips slightly below view." 

The physicians spent ten days on a seal hunting expedition 
led by an elderly Inuit, who was attuned to traditional ways 
and spoke no Enghsh, and his son, who spoke both Inuktitut 
and EngUsh. In gratitude for a gift of huskies — transported 
from the opposite end of the world, the Antarctic — the father 
and son had extended an in\Ttation to the donors and some of 
their friends to join them on the expedition. During the day, as 
the Inuit caught and butchered seals, Wilson and the other 
guests rode along on the dogsleds. They would often hop off 
and help push the sleds in places where the snow was too 
deep or a hummock of ice too high. 

"Those dogs just love to pull the sleds," Wilson says. 
"They wag their tails and try to wriggle into their har- 
nesses. Sometimes their ropes get tangled, and they snarl 
and snap at each other. But otherwise they're quite good- 
natured." Other Arctic animals, however, failed to endear 
themselves to Wilson; he declined an opportunity to 
observe polar bears at close range. "We did spot a mother 
with a cub about a quarter mile away," he says, "which 
was about as near as we wanted to get." 




28 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



The hunting party spent a week hving in the Inuit fam- 
ily's hunting shack on the edge of the ocean ice, ten miles 
from town. The shack was primitive, Wilson says — sim- 
ply a two-room wood cabin warmed by propane gas. To 
avoid overcrowding, Wilson opted to sleep in one of the 
family's nearby igloos for a few nights. It was larger than 
he had expected, and he could even stand up in it. 

"Light came through the ice and heated the igloo," he 
says, "so it was quite cozy." But, he adds, "If I had to get up 
in the middle of the night, I was in for an adventure. I 
would bundle up and try to sneak out onto the ice, but I 
would still wake the sled dogs, who were always on the 
alert for polar bears. As they howled, I would look up at 
the moon, which was crisp and beautiful, even with the 
sun at the horizon. But I wouldn't linger — it was so cold, 
I'd skedaddle back to the igloo." 



In the Arctic, Wilson discovered, beauty and danger go 
hand in hand. "One of the risks is that, every once in a 
while, a piece of pack ice will break off and float away," he 
says. "Any unfortunate souls caught on the breakaway 
piece may starve to death as they drift aimlessly in the 
ocean. Our hosts had lost a family member that way about 
15 years earlier." 

The Arctic adventure has been just one of many for 
Wilson. As a psychiatrist with a private practice in Wash- 
ington, DC, he says, "I sit and talk to people all day, so I 
like to be physically active during my time off." He has 
climbed Mount Kilimanjaro, scuba dived in Belize, 
trekked in Nepal, and studied high-altitude medicine in 
the Andes. But the Arctic, he says, offered him "a cultural 
experience that was unique and wonderful — everything I 
had imagined as a boy." ■ 



i^m 



eorgiana Boyer '55 



ON HER FIRST TRIP TO THE ARCTIC, GEORGIANA BOYER BECAME 

coated with mud. For several days, she and one of her 
daughters lived in a tent at a fishing camp outside the 
small Inupiat village of Kotzebue, Alaska. "It was sum- 
mertime," she says, "and when the rains came, the mud 
just covered us. It was not exactly Manhattan — and it 
appealed to us very much." 

Boyer's housing in Alaska improved only marginally 
over the next decade, when she undertook a collaborative 
arthritis research project among Alaskan Natives. As she 
traveled from village to village, she was often put up in 
local clinics. "I stayed in some wonderful, hysterical 
places," she says. "In one clinic, my research partner slept 
in a body carrier. I was worried about falling off the exam- 
ining table in the middle of the night, so I slept on the 
floor, using padding from the EKG as a mattress." 

In another tiny community, local entrepreneurs decid- 
ed to rent out rooms in a small, dilapidated house whose 
windows were covered with trash bags. Each room came 
with either a lightbulb or a mattress. Boyer, whose room 
featured a naked lightbulb, snuck in a mattress, since 
she did not relish the idea of sleeping on the bare floor. 
Just as she was triumphantly settling down for the 
night, she realized that the room partitions were flimsy 
at best, and she was subjected to every nuance of her 
neighbor's snoring. 




Boyer adopted her 
nomadic lifestyle after 
retiring from a research 
career in virology and 
immunology to raise 
five children. "When my 
youngest was ten, I real- 
ized it was time to get 
back to work," she says. 
"So, while wearing granny glasses, I undertook a resi- 
dency in preventive medicine." 

From 1984 to 1988, Boyer conducted rheumatic disease 
surveys among the Inupiat and Yupik of northern and 
western Alaska, the Athabascans in the state's interior, and 
the Tlingit and Haida in southeastern Alaska. Then, when 
the National Institutes of Health, the Indian Health Service, 
and the Institute of Rheumatology in Moscow joined forces 
to study arthritis among native peoples of the Arctic, Boyer 
was invited to participate. From 1990 to 1996, she conduct- 
ed clinical and epidemiological studies in Alaska while a 
Russian group conducted corresponding studies among 
the Yupik and Chukchi in Siberia. 

Project staff were studying spondyloarthropathy, a type of 
arthritis that occurs more frequently in people with B-27, an 
HLA antigen common among Arctic peoples. The detailed 
btrth-to-death records of the Alaska Native Health Ser\Tce 
provided an unusual source of information about the course 
of the disease. Among other findings, Boyer and her fellow 
researchers discovered that many of the people with spondy- 
loarthropathy had gone undiagnosed, because their often 
mild cases did not fit the classic descriptions of the disease. 
For the six years of the study, Boyer commuted 
between Alaska and her home in Arizona. "We tended to 
make our clinical visits during the winter," she says. "Dur- 
ing the summer, people were out hunting and fishing, but 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



CIRCLING THE ARCTIC: 
A. Georgiana Boyer 
visits Point Lay, a 
small Inupiat village 
on the northern 
slope of Alaska. 
B. Boyer stands 
beside a sign for 
the Utkeagvik Pres- 
byterian Church in 
Barrovs^ Alaska. The 
sign is fashioned 
from the scapula of 
a boNvhead >vhale. 




J' 




in the winter, they often had nothing else to do, and they 
viewed coming to our clinics as a kind of outing." 

Boyer found that such work was not for everyone. "I 
discovered two strong reactions to Alaska among the 
other health workers visiting from the Lower 48," she 
says. "Members of one camp were eager to escape, while 
people in the other camp fell in love with it right away. 
There seemed to be no middle ground." 

Alaska's rugged terrain and extreme temperatures 
appealed to Boyer. "I grew up in the intense heat of Ari- 
zona," she says, "and I found a lot of similarities between 
the two states. Both are wide, wild, unspoiled places. The 
original people who inhabited both areas had to be tough 
and wily. And I didrit mind the cold and the dark, because 
it was cozy inside, where everyone was hunkered down. 



"The Arctic peoples are amazing," she adds. "In the 
Lower 48, we have so much support. And while we think 
we need a certain amount in terms of amenities, they have 
been enduring harsh conditions for thousands of years." 

Residents of Barrow, the northernmost community of 
Alaska, would ask Boyer, "Is it cold enough for you?" and 
then laugh uproariously. One summer day, while boarding 
a plane to Barrow, she overheard one native saying to 
another, "Fairbanks is so hot — it even got up to 70 above!" 
"Only in Alaska," she laughs, "would they think to differ- 
entiate 70 above' from 70 below!'" 

One April day, while in Barrow, Boyer attended an Inu- 
piat festival celebrating the start of the spring whaling 
season. "We watched a wonderful parade," she says. "The 
water truck passed by, followed by a dump truck, then 
road equipment. The drivers threw candy to the children, 
and it skittered across the ice." 

In another village, just north of the Arctic Circle, a 
health aide teaching an apprentice how to give injections 
espied the visiting doctor and pohtely asked if they could 
practice on her bottom. "I sure thought I was giving my all 
for medicine!" Boyer says. 

Although she has enjoyed her trips to the Arctic 
tremendously, Boyer has taken a break from research after 
losing one of her sons in a climbing accident just over a 
year ago. She now volunteers on archeological sites near 
Tucson. "Mine isn't the usual retirement," she says. "There 
I am, out in the boondocks, shoveling through dirt, in 
search of ancient treasures." 

Boyer does plan to return to Alaska, which she misses 
greatly. "Nothing I've done professionally has matched 
that experience," she says. "Alaska is so wild, beautiful, 
and unspoiled. As I'd fly over some remote, breathtaking 
Arctic scene, I'd think. They're paying me to do this?'" ■ 



30 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



dgar Miller, Jr. '54 



"WHEN THE LORD MADE THE EARTH, HE PUNCHED HIS THUMB 

through the top, then out through the bottom," says 
retired surgeon Edgar Miller, Jr. "So the North Pole is sub- 
merged thousands of feet below water, while the South 
Pole rises thousands of feet above." 

Miller, who has visited both extremes, prefers the north, 
even though he finds the south more beautiful. "The North 
Pole isn't as pretty as its southern counterpart, because it's 
just pack ice and ridges," he says. "The farther north you 
go, the more desolate it is, with ice just crammed up on itself. 
Yet there's something about the Arctic that I find captivating. 
It may be because people have hved up there for thousands of 
years. I've always found it fascinating, how the Eskimos have 
survived and even thrived ki those harsh conditions." 

Eor several weeks in 1992, MfUer served as ship's surgeon 
on an expedition to the North Pole on the Sovetskiy Soyuz a 
nuclear-powered Russian icebreaker. Through a fellow 
member of the Explorers Club, he had learned that a tour 
company in Connecticut was chartering the icebreaker and 
staffing it primarily with Russians. For four days each way, 
the ship would be beyond radio contact, so a doctor was 
needed. Miller signed up. 

One of a handful of nuclear icebreakers that the Soviets 
operated during the Cold War, the Sovetskiy Soyuz can break 
through ice up to 15 feet thick. On Miller's trip to the Arctic, 
the ship carried two heUcopters to fly reconnaissance, as 
well as onboard forecasters to help the captain plot the best 
course through the ice. The ship had multiple decks, with the 
tourists staying on the upper levels. "It was a free trip for me," 
MiUer says, "so I was housed with the staff below, where all 
that grinding through the ice was deafening. It sounded hke 
the ice was coming up through my bunk." 

The icebreaker stopped at a few Inuit villages in eastern 
Siberia. When it passed Wrangel Island, host to the 
world's highest concentration of polar bears. Miller sight- 
ed about two dozen of them. "They'd smell our food and 
come right up to the ship," he says. "We also saw a tremen- 
dous number of birds, and hundreds of walruses. The 
wildlife was just spectacular." 

When the ship reached the North Pole, everyone disem- 
barked onto the ice, where they held an American-style 
barbecue. The Russians took advantage of the path the ship 
had broken, by going in for a dip, equipped with just inner 
tubes and vodka. Their swim lasted less than five minutes. 
"Some of the tourists jumped in as well, but they seemed to 
get out faster than they went in," Miller says. "As their doc- 
tor, I insisted that they have a rope tied around them." 



ICE CAPADES: Edgar Miller's trip to the 

North Pole on a Russian icebreaker >vas filled 

v/\\h the remarkable sight of Arctic >vildlife 

and the deafening sound of ice being crushed. 




Miller's appetite for the Arctic was 
whetted at Dartmouth, where he 
spent his undergraduate days and the 
first two years of medical school. He 
had always enjoyed reading about Arc- 
tic exploration, and during his fresh- 
man year he met VUhjaknur Stefans- 
son. The famous polar explorer gave a lecture on physiology, 
extolling the virtues of an Arctic subsistence diet, which he 
had adopted while living with the Inuit in northern Canada. 

Miller was hooked. While stiU in college, he worked for 
two summers on a schooner in the waters near Newfound- 
land and Labrador, on behalf of an Arctic research institute. 
There, he says, "I got a feel for the subarctic. I treated Eski- 
mos and saw icebergs, but it was stiU only the subarctic." 

After graduating from HMS and undertaking a surgical 
residency, MiUer served in the Navy, which sent him to the 
Antarctic, where he spent a year helping to build the U.S. 
base at McMurdo Sound. Eor the next four decades, until 
his retirement two years ago, he worked as a general surgeon 
in a solo practice in Wilmington, Delaware, where he had 
grown up. But he had also grown up with parents who, as 
physicians and missionaries, had started a hospital in Kath- 
mandu in the 1950s. With such role models. Miller had 
developed a craving for adventure. So every year or two, he 
would take a month's leave from his Wilmington practice to 
teach medicine or conduct surgery in a developing country. 
Miller followed his trip to the Arctic with one to the 
Antarctic the same year, also as ship's surgeon. Despite a 
wonderful voyage, he maintains his loyalty to the Arctic. 
"I'm convinced that tourists visit the Antarctic," he says, 
"while true explorers venture north." ■ 

Paula Byron is editor of the Harvard Medical Alumni Bulletin. 







WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



31 






r>'^i 



pas* J^a^ft■,>^^1i^Myt^i^5^Jl^^'gJyarf;«?A8fiMf ji^f*^^ 





AN ANESTHESIOLOGIST UNCOVERS MEDICAL CLUES IN THE 
UNUKELIEST OF SETTINGS— THE ANTARCTIC 



i^. 



t NOT-SO-FAIR-I 

WEATHER FRIENDS;* 

Warren Zapol and "a':[ 
flock pf^ erriperor'^"' 
penguins on the ice ;r* 



M"^- _ ,- 







Susan Cassidy 

WALK INTO WARBEN ZAPOL'S OFFICE AT MASSACHUSETTS GENERAL HOSPITAL 

and you immediately recognize signs that a polar scientist is in res- 
idence. Framed photographs on the wall show research teams bun- 
dled up in red parkas; in one photo, Zapol and a flock of emperor 
penguins cavort on the sea ice; deHcate drawings depict Antarctic 
creatures. Zapol has led nine expeditions to the South Pole, and 
although his "day job" as head of the Department of Anaesthesia and 
Critical Care at MGH, and Reginald Jenney Professor of Anaesthesia 



the laboratory, the seal doesn't know how long it will 



34 



at HMS, precludes such travel for 
the time being, Zapol has maintained 
a deep connection to the Antarctic, 
which he calls "the most beautiful place 
in the world." 

On his first trip to Antarctica, in 1974, 
Zapol's research centered on measuring 
the blood pH offish. But he quickly shift- 
ed his attention to one of the South Pole's 
warm-blooded creatures, the WeddeU 
seal, which has the amazing ability to dive 
deeper than 500 meters and stay under- 
water for more than 90 minutes. "They'd 
probably do a thousand meters," Zapol 
says, "only they'd hit the bottom." He 
points out that while a human who can 
swim unaided to a depth of 20 meters and 
stay submerged for three minutes is con- 
sidered an expert diver, that abiUty pales 
in comparison to the behavior of this seal, 
which has developed adaptations that 
allow it to withstand the intense pressure 
of deep-sea diving, not to mention the 
lack of air and the extreme cold. 

Zapol adds that one of the greatest 
dreams in medicine is to find a way to 
shut down the metabohsm when the 
body cannot supply oxygen and elimi- 
nate waste products, particularly dur- 
ing acute heart attacks and strokes. "If 
you knew how to shut down the 
metabohsm, much as the seal can," he 
says, "you could preserve the brain and 
the heart from injury." 

Diving Virtuosos 

During a dive, the seal must provide its 
tissues with oxygen, limit buildup of 
carbon dioxide in the blood, and avoid 
various ills of extreme pressure, such 
as nitrogen narcosis — what divers 
call "rapture of the deep." And if the 
nitrogen tension in blood and tissues 
becomes too great as the seal swims to 
the surface, the result can be "the 
bends," a condition that may lead to 
blocked blood vessels in the brain and 
spinal cord, paralysis, and even death. 
So how do Weddell seals overcome 
these obstacles? Laboratory studies have 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



provided some important clues. The 
seals store twice as much oxygen per 
kilogram of body weight as humans, and 
they concentrate it mainly in the blood. 
Human divers depend on their lungs for 
oxygen storage; seals do not. Another 
adaptation is bradycardia, or slowing of 
the heart rate. Further, some of the seal's 
tissues stop functioning during a dive; 
others switch to anaerobic metabohsm. 
Yet to fnUy understand the adapta- 
tions that allow Weddell seals to pene- 
trate to such incredible depths and stay 
submerged so long, field studies are 
required. "Forcing a seal confined in a lab- 
oratory to put its face underwater does 
not necessarily evoke the same response 
as a dive undertaken freely in the sea," 
Zapol says. So, on six occasions, he and 
his team headed to the National Science 
Foundation's research station on the 
shore of Antarctica's McMurdo Sound to 
study the behaxdor of the seals in the wild. 

Wild Discoveries 



Zapol and his colleagues generally made 
their trips during the Antarctic spring in 
October, when the sea ice is still thick 
enough to allow planes to land directiy 
on it. The researchers Hved and worked 
on the ice itself, on expeditions that 
lasted two or three months. 

To allow the scientists to understand 
metabohcaUy what happens when a seal 
dives at sea, Roger Hill, then a physicist 
and medical researcher at MGH, devel- 
oped software and built a battery-oper- 
ated computer that could be glued to a 
seal's dorsal fur. Other researchers were 
finding out how deep the seals went, but 
Zapol and his team wanted to learn 
more — to record the seal's heart rate, for 
example, and to sample and measure the 
amount of nitrogen in its arterial blood 
during dives. Hill's diNong computer was 
able to record the seal's heart rate and 
depth at predetermined intervals. It also 
controlled an electric pump that took 
blood samples. Now all the team needed 
was a few willing research subjects. 



The team gathered young male seals 
from colonies near the shore and sledged 
them to the study site, usually about five 
to ten rrules offshore. The researchers 
would then have a three-foot-diameter 
hole drilled through the sheet of ice 
roughly six feet thick, in a place with no 
nearby cracks through which the seal 
could surface. "That way," Zapol says, 
"the seal couldn't swim away with ten 
thousand dollars worth of computer 
equipment on its back." 

In a harmless process, the seals were 
anesthetized, catheters were inserted, 
and the computer was attached. When 
the seals recovered from the anesthesia, 
they entered the hole and swam away. 
Because they could swim only a few kilo- 
meters underwater, they had to return to 
the hole to breathe, so the researchers 
knew they'd be seeing the seals again at 
the end of each dive. Zapol found the seals 
to be wonderful to work with, recalling a 
particular favorite named Max — "After a 
while, you get to know the seals," he 
explains, "and even name some of them." 

For shelter against the elements, the 
research team used a small hut on skis 
that was towed across the ice to the 
desired location. A hole cut out of the 
bottom of the hut was positioned over 
the hole in the ice. That room also housed 
a computer to retrieve data from the div- 
ing computer when the seals returned to 
breathe. Another small hut formed the 
research team's Hving quarters, complete 
with bunks, a cookstove, and a heater. 

Zapol and his fellow researchers soon 
learned that the seals' di\Tng responses 
did not quite match what they had seen 
in the laboratory. They found that 95 
percent of the seals' voluntary dives 
were short, feeding dives, lasting less 
than 20 minutes; the animal would head 
straight down for its prey, the Antarctic 
cod, and then resurface. Only 5 percent 
of the dives lasted longer than 20 or 30 
minutes; these longer dives would occur 
when the seal was exploring new terri- 
tory or escaping from predators. The 
longer dives were characterized by 



be submerged/' Zapol explains, "so it prepares for the worst.'" 



bradycardia with little variability of 
heart rate; on the shorter trips, the seal's 
heart rate would quicken and slow in 
accordance with its swimming speed. 
Yet in the laboratory, even short dives 
had evoked the response typical of a 
long dive. The reason? "In the laboratory, 
the seal doesrit know how long it will be 
submerged," Zapol explains, "so it pre- 
pares for the worst." 

Zapol and his team also focused on 
what he refers to as two of the seal's 
great secrets: its use of the spleen as a 
storage tank for red blood cells, and its 
abihty to collapse its lungs. Zapol and 
his colleagues estimate that the Wed- 
dell seal stores about 60 percent of its 
red blood cell supply in the spleen 
(humans store less than 10 percent). 
"The seal's spleen appears to be some- 
thing of a contractile scuba tank in its 
abihty to store and release red ceUs 
needed for diving," Zapol says. 

From their field studies, Zapol and his 
team also learned that the seals' lungs col- 
lapse at the beginning of each dive. This 
collapse decreases buoyancy, making it 
easier for the seal to descend, and limits 
the amount of nitrogen that can enter the 
blood during a dive. "When people go for 
a long dive, they breathe in, to fiU up their 
lungs. Seals do the opposite; they breathe 
out when diving to help collapse their 
lungs," Zapol explains. "It's such a smart 
technique; we found that out early when 
we measured the amount of nitrogen in 
their blood and noted that it didn't rise to 
the levels that a human scuba diver's 
would rise to." Thus the seal is able to 
remain alert during deep dives, allowing 
it to find and capture its prey without 
succumbing to nitrogen narcosis. 

The researchers also wondered if seal 
fetuses exhibit the diving reflex when 
their mothers descend. A heart rate mon- 
itor attached to pregnant seals showed 
that fetal heart rates slow during dives, 
though more gradually than the mothers' 
heart rates. "The fetus 'knows' when its 
mother dives," Zapol says, "though 
exacdy what informs it is not clear." 




Zapol continues to be fascinated by 
many of the seals' behaviors, particular- 
ly the mechanism by which they can 
coUapse and inflate their lungs, which 
will be a focus of future research. "Any- 
one with a reasonable amount of curios- 
ity could spend a lifetime in Antarctica 
studying Weddell seals," he says. 

Although his work at MGH now 
takes priority over research expeditions, 
Zapol did travel to the Antarctic in Feb- 



ON THICK ICE: A. The Weddell seal can stay 
undenvater more than 30 times longer than 
expert human divers. B. From left: Roger Hill, 
Warren Zapol, and Robert Schneider take a 
break outside their hut. C. Hill attaches a 
computer monitor to a seal's dorsal fur. 



ruary 2000, this time as a guest lecturer 
and accompanied by his wife, Nikki, on a 
cruise sponsored by the Harvard Muse- 
um of Comparative Zoology. Instead of 
hving for months in a hut on the ice, they 
stayed on a well-appointed ship and 
made only brief forays ashore. StiU, Zapol 
says, "It was like going home." ■ 

Susan Cassidy is assistant editor of the 
Harvard Medical Alumni Bulletin. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



35 






VERTICAL LIMIT: 
Mount Cook is 
the spectacular 
yet dangerous 
peak that nearly 
cost two HMS 
friends their lives. 



Wf^» 




I 






by Beverly Ballaro 



N MOUNTAINEERING, THE LINE BETWEEN 

adventure and disaster can run per- 
ilously thin. Sur\dvors draw upon WTts, 
guts, and pure luck to deliver them- 
selves and their sometimes harrovving 
tales safely home. It was such a combi- 
nation that saved Stephen Arnon 72 
and George Merriam 75 during a cHmbing vaca- 
tion turned wilderness survival marathon. 

Merriam had cultivated a taste for adventure 
during his undergraduate days when, like Arnon, 
he belonged to the Harvard Mountaineering Club 
and sen'ed as president of the Harvard Outing 
Club. During his HMS career, he undertook some 
risky climbs in the Swiss Alps and Alaska, and 
later traveled to the Antarctic Peninsula. 

Arnon, too, had endured his share of close calls 
over the years. Once, on an Alaskan expedition, he 
and his fellow climbers lost their bearings on 
rugged Mount St. Elias. A fierce storm had blowm 
in off the Gulf of Alaska, burying the wands the 
men had used to mark their descent route, and 
forcing them to bi^'ouac overnight in the blirzard. 
To find their way dowTi from the surmrdt in white- 
out conditions, the climbers had to mo\'e one 



excruciating rope length at a time, fanning out 
pendulum-fashion until they stumbled across each 
buried marker. 

When Arnon agreed to accompany Merriam on 
a 1980 climbing vacation, both men still enjoyed 
outdoor adventures, but they no longer sought out 
the kind of risky outings they had undertaken in 
the past. They set their sights on Mount Cook, a 
spectacularly beautiful mountain and the highest 
peak in New Zealand. To increase their margin of 
safety, they took the precaution of hiring profes- 
sional guides famihar with the local terrain and 
New Zealand's notoriously capricious alpine 
weather. Ironically, it was the judgment of these 
experts that would lead Arnon and Merriam to 
their most dangerous adventure ever. 

With an elevation of 12,349 feet. Mount Cook 
dominates the majestic Southern Alps. Arnon and 
Merriam's original plan called for them to tackle the 
standard route. After climbing other peaks \\'ith 
them, though, their guides felt that the men were 
strong and skilled enough to undertake "the Grand 
Traverse" of Mount Cook: they would first gain the 
main summit, then work sideways along the sub- 
sidiary peaks that make up the mile-long knife- 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



37 



our consternation when the three-foot handle poked 



edged summit ridge. They would spend 
one night bivouacked on the ridge before 
descending more than 10,000 feet to park 
headquarters the following day. 

Arnon and Merriam, along with their 
guides, departed around midnight. Dark- 
ness actually made for safer conditions, as 
their plarmed route traveled beneath a 
hanging glacier; by day, the sun's warmth 
would melt the ice and increase the threat 
of avalanche. Along the way, they decided 
to join up with another two-man team 
who happened to be climbing the same 
route. After a strenuous but exhilarating 
effort, the group arrived at Mount Cook's 
summit around noon. 

Nowhere to Hide 



38 



At the summit, an ominous sight awaited 
them. The climbers were startled to see, 
below their own elevation on the summit, 
enormous black clouds biUovvong toward 
them from the southwest across the Tas- 
man Sea. Realizing that there would be no 
time to make a safe descent ahead of the 
approaching storm, the guides decided 
that the wisest course of action would 
be to sit out the weather in a sheltered 
bivouac. As part of their certification 
training, they had practiced emergency 
bivouacs in the uppermost crevasse locat- 
ed just under Mount Cook's Middle Peak. 
Unfortunately, the desired crevasse lay sev- 
eral hours of delicate climbing in the dis- 
tance, and the storm engulfed the climbers 
well before they could reach its \acinity. 

After much tense searching by flash- 
light through the blizzard, the guides were 
finally able to locate the snow-covered 
opening of the crevasse. Their discovery 
led to a cautious one-man exploration of 
its interior to confirm its stabihty. It 
appeared to be safe enough; besides, there 
was nowhere else to go. "It was a snug ht- 
tle ice cave," Merriam recalls, "just big 
enough for all six of us." 

Their comfort was short-hved. Once 
inside, one of the chmbers probed the 
crevasse floor with his ice axe. "You can 
imagine our consternation," Arnon says. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



"when the three-foot handle poked clean- 
ly through the floor to reveal a bottomless 
abyss below. Everybody moved a httle 
more gingerly after that." Dehydrated and 
exhausted, the group settled down to 
sleep as best they could, consoled by the 
hope of completing the Grand Traverse 
the next day. 

The mountain, however, had other 
plans for them. By morning, the blizzard 
had rendered the world outside the cave 
in\'isible. Arnon woke up unable to move 
his legs, because he was buried up to his 
waist in snow that had blown into the cave 
overnight. The climbers stamped the snow 
down as best they could, as they had 
brought along no shovels. 

The guides also had neglected to bring 
stoves. In part, says Arnon, "It was a clas- 
sic case of, 'Oh, I thought }'0U were going to 
bring the stove.'" But, adds Merriam, "we 
had been well-equipped for our original 
planned route. We just hadn't anticipated 
a storm of that intensity." The specters of 
hypothermia and dehydration began to 
loom large in the climbers' minds. 

As the storm continued to fiU their 
cave with snow, Arnon remembered a 
maxim learned in boyhood. As a 12-year- 
old watching a mountain blizzard, he had 
heard an old Sierra Club lodgekeeper 
mutter, "Where the wind don't blow, the 
snow won't go." He immediately began 
fashioning a wall of snow blocks, cut one 
by one with an ice axe, to act as a barrier 
against the wind, and Merriam soon 
joined him. "Initially, the guides chuckled 
at our efforts," Arnon recalls, "but, in the 
end, those words of vwsdom prevented us 
from being buried aUve." 

The Perfect Storm 



What the climbers could not know as they 
shi\'ered in their ice cave was that they had 
stumbled into no ordinary storm. In a 
twist of fate, the weather map the guides 
had consulted before setting out ended 
just short of revealing a massive Antarctic 
airstream system. Such a pattern consists 
of a continuous eddy of powerful winds 



that generate not one storm but a series of 
blizzards that can last up to two weeks. 

During the brief interludes between 
storms, the climbers were able to emerge 
from their shelter and gaze down onto the 
coastal plateau to the west of Mount 
Cook. "The breaks lasted just long 
enough to tease us," Merriam remembers. 
"Ironically, it was harvest time in New 
Zealand. We could see farmers 12,000 feet 
below tiUiiig their fields. The juxtaposi- 
tion of the green, pastoral scene below us 
and the wintry, Alaska-like conditions 
that had us trapped high on the summit 
was absolutely surreal." 

The guides took advantage of a shght 
break in the weather to traverse the face of 
the mountain and plant a series of ice axes 
in the snow. To these axes, they knotted 
orange plastic bags they had brought 
along to keep clothing dry. Their aerial 
markers set out, they scrambled back to 
the cave to pray that someone would see 
the distress signal. For the next couple of 
days, they could do nothing but wait. 

"We were pretty miserable," Arnon 
remembers, "between the cold and the 100 
percent humidity." Adds Merriam, "This 
was before synthetic water-shedding fab- 
rics had become widely available. Our 
clothes and down sleeping bags were wet 
and freezing." The climbers' only food con- 
sisted of candy bars, which they carefully 
rationed. Their water supply had long 
since run out. To avoid further dehydra- 
tion, they scraped snow into water botdes 
and then melted it by tucking the bottles 
into their armpits or groins. The guides 
remained confident that help would come. 
"After three days," Arnon recalls, "the 
Kiwis sent out a search party. They knew 
that, by then, we had to be either in the 
IvUddle Peak crevasse or dead." 

The guides' ingenuity was finally 
rewarded when a search plane spotted the 
orange markers during a two-hour break 
in the storm. Unfortunately, being found 
was only the first step to being rescued. 
The summit of Mount Cook was too high 
for any available hehcopter to carry off a 
group of people; at that altitude, the 



cleanly through the floor to reveal a bottomless abyss below." 



atmosphere was so thin that there simply 
wasn't enough air for the rotor blades to 
generate adequate Mt. Besides, treacher- 
ous windshear conditions would have ren- 
dered any landing attempt impossibly 
dangerous, and there really was no landing 
place; the narrow summit ridge was delin- 
eated by sheer ice faces that dropped off 
several thousand feet on both sides. 

A small helicopter did return the next 
day, however, and hovered near the crevasse 
entrance long enough to lower sacks con- 
taining hot soup, dry socks, a stove, and a 
two-way radio for communication with 
the outside world. "And, believe it or not," 
Amon recalls with a laugh, "those crazy 
Kiwi pilots also threw in some Playboy mag- 
azines." One of the guides, worried about 
her frostbitten toes, promptly decided that 
the centerfolds made excellent insulation 
material for her boots. 

Their magazines put to practical use, 
the climbers devised other ways to wile 
away the days. "Our minds were blank 
much of the time," Arnon says. "Both the 
cold and boredom were numbing. Mostly, 
we just focused on trying to keep warm 
and drinking water to survive. But we did 
share our life stories with each other and 
we joked about our situation. George 
kept notes on the back of a topographic 
map and promised to acknowledge 'the 
hospitahty of the Middle Peak Hotel,' as 
we had nicknamed our ice cave, if we ever 
got rescued." Merriam, who had been a 
member of the Harvard Glee Club, also 
led the group in an occasional song. 

The radio enabled Arnon and Merriam, 
who were about to miss their scheduled 
flight home, to take the rescue authorities 
up on their offer to relay messages to their 
famihes back in the States. "We didn't 
want to alarm anyone, especially when 
there was really nothing that anybody 
back home could do to help," Arnon 
remembers. "I think the message we sent," 
says Merriam, "was something subdued, 
along the Hnes of 'Snowbound in moun- 
tain lodge, but safe and well.'" 

Four days after their sighting by air 
and one week after their initial strand- 



ing, the chmbers received word of a pro- 
jected daylong break in the storm and 
decided to seize the narrow window of 
opportunity. On a vwndy, cold, but sunny 
day, they continued the traverse until 
they could rappel from the summit ridge 
to a glacier some 2,000 feet below the ice 
cave. Their greatest obstacle on the chmb 
down was sastrugi — small wind-carved 
asymmetrical elevations that snagged 
their ropes at every opportunity and sub- 
stantially slowed their progress in the 
face of the storm's expected return. 
Working together as mountaineers, they 
raced against the clock. 

Once on the lower shelf of the glacier, 
the climbers were airUfted to safety, two 
at a time. Both Merriam and Arnon were 
frostbite-free and relished the shock ot 
being surrounded by greenery again 
after days of nothing but white and blue. 
They devoured a sumptuous celebratory 
meal to start replacing the more than 15 
pounds each had shed during the ordeal. 
They also discovered that they were front- 
page news throughout New Zealand, hav- 
ing unintentionally set a record for the 
longest, highest bivouac in that coun- 
try's history. 

Calm After the Storm 



Asked afterward by television inter- 
viewers whether his experience on 
Mount Cook had altered his attitude 
toward chmbing, Arnon responded with 
a resolute no: "We chose to be on that 
mountain in the first place. Risk is a part 
of the sport. We went for the aesthetic 
thrill that mountaineering provides." 

The ordeal transformed Merriam's 
outlook for the better; "After I got home, 
I found myself extraordinarily grateful 
for the little joys of daily life and much 
more tolerant of minor hassles." He 
echoes Arnoris perspective on risk: "I 
still cherish the wilderness. Although 
I've steered clear of high-risk outings 
since becoming a father, I take my wife 
and daughter on hikes all the time. 1 con- 
tinue to view the most dangerous part of 



NEW LATITUDE: George 
Merriam stands atop 
Antarctica's Penguin 
Island in 1997. Merriam 
is a professor of medi- 
cine at the University of 
Washington, specializing 
in neuroendocrinology. 




any adventure as the freeway drive there 
and back; I feel perfectly safe and com- 
fortable out in the wild." 

Some years later, Arnon and Merriam 
learned that their record had been broken 
by another group of climbers who had got- 
ten caught in a series of blizzards that 
raged for two full weeks. Although mem- 
bers of that later expedition survived, sev- 
eral lost parts of their feet to frostbite. The 
climbers in that group sought refuge in the 
very place that had previously sheltered 
the HMS friends and their companions. 

The newer record wUl hve on unbro- 
ken. Mount Cook's glaciers remain active; 
the Middle Peak crevasse, where Arnon 
and Merriam bivouacked in an Antarctic 
storm and hved to tell their tale, no longer 
exists. A decade after their historic ad\'en- 
ture, it collapsed into a massive avalanche 
and disappeared forever. ■ 

Beverly Ballaro is associate editor of the 
Harvard Medical Alumni Bulletin. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



On call in the 





HOW CAN PHYSICIANS INCORPORATE ADVENTURE INTO THEIR LIVES— AND 
MEDICINE INTO THEIR ADVENTURES? by BEVERLY BaLLARO 



FROM SEA FLOORS TO MOUNTAINTOPS, SOME OF THE EARTH'S MORE 

majestic natural settings are attracting doctors interested 
in practicing their skills well outside the traditional con- 
fines of hospital and research laboratory. Extreme set- 
tings — ^windwhipped glaciers, steamy tropical jungles, and 
parched deserts — require extreme medicine, as well as doc- 
tors of a mindset and physical conditioning to enjoy the 
splendors and hardships of the wild. Many of those willing 
to take up the challenge report that their adventures have 
provided them with some of the 
most richly rewarding spiritu- 
al, intellectual, and athletic 
experiences of their lifetimes. 
Physicians seeking a crossover 
between medicine and adven- 
ture may turn to a number of 
organizations dedicated to cre- 
ating this kind of connection. 

The Wilderness Medical 
Society currently has more 
than 4,000 individual members. 
It was founded in 1983 to 
encourage and conduct activi- 
ties and programs aimed at 
improving the scientific knowl- 
edge of its membership and the 
general public in matters relat- 
ed to wilderness environments 
and human activities therein. 
The society's research grant 
program offers significant 
funding for original projects at 
the medical student, resident, 
graduate, feUow, and postgrad- 
uate or member levels. Grants 
are awarded annually. 




ST. ELSEWHERE: A Himalayan Health Exchange 
physician examines a young patient. 



Society curriculum offerings, approved for continuing 
medical education credit, focus on a variety of topics: 
hazards of environmental exposure; cold and head injury; 
altitude illness; dive medicine; trauma; white-water injury; 
search and rescue; resuscitation; survival techniques; 
hazardous marine life; mammalian bites; venomous bites 
and stings; infectious diseases associated with travel; 
medical fitness for wilderness sports; nutrition for wilder- 
ness activities; and expedition medical planning. 

Publications include the 
quarterly Wilderness Medicine Let- 
ter, the Wilderness Medical Society 
Practice Guidelines for Wilderness 
Emcrgencs' Care, and Wildaiicss and 
Environmental Medicine Abstracts 
and reprints of journal articles 
past and present are available 
through the society's web site. 

The society holds its armual 
general meeting at a different 
location each summer and reg- 
ularly hosts topic-specific 
meetings — on themes such as 
winter wilderness medicine 
and tra\'el, desert, and dixing 
medicine — featuring expert 
speakers drawn from the out- 
door community. In addition, it 
arranges quadrennial World 
Congresses to review the status 
of wilderness medicine activi- 
ties around the globe. Detailed 
descriptions of upcoming 
courses and meetings can be 
found on the the society's web 
site. Events scheduled to take 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



place in 2001 include: a winter wilder- 
ness and travel medicine course in 
Colorado; a Great Smoky Mountains 
wilderness medicine seminar in Ten- 
nessee; and a marine and dive medicine 
course in Mexico. 

The International Society of 
Travel Medicine, which has 1,200 
members in 53 countries, is committed 
to the promotion of healthy and safe 
travel. The society facilitates educa- 
tion, service, and research activities 
related to topics such as: preventive 
and curative medicine; tropical medi- 
cine; infectious diseases; high-altitude 
physiology; travel-related obstetrics; 
psychiatry; occupational health; mili- 
tary and migration medicine; and envi- 
ronmental health. Grants are available 
through a peer-reviewed, competitive 
process to members interested in trav- 
el medicine research, and a clinical tri- 
als network conducts collaborative 
research. Physicians can receive con- 
tinuing education credits. 

The society holds a biennial confer- 
ence; offers a quarterly publication, the 
Journal of Travel Medicine; and publishes a 
quarterly newsletter called NewsS/iare. 
The society's web site includes a travel 
clinic directory and features updates 
on travel medicine, outbreak informa- 
tion, and opportunities for communica- 
tion with travel medicine colleagues. 

The International Society of 
Aquatic Medicine was formed in 1975 
by physicians whose common inter- 
ests centered around scuba diving and 
diving medicine. The society offers 
unique opportunities to dive in exotic 
places and, at the same time, to obtain 
knowledge and earn continuing med- 
ical education credit. It organizes pro- 
grams on topics such as hyperbaric 
medicine, diving safety, venomous ani- 
mal stings and bites, and the diagnosis 
and treatment of diving injuries. The 
society also publishes a quarterly to 
keep its 1,800 members abreast of new 
developments in diving medicine. 

The Mountain Rescue Associa- 
tion, established in 1958 to improve 
care of the sick and injured in the 



mountains, is a volunteer organization 
dedicated to saving lives through res- 
cue and mountain safety education. It 
consists of more than 80 units in the 
United States, Canada, and other 
countries. Medical skills and certifica- 
tions, as well as the ability to work 
with a team, are among the considera- 
tions for membership. 

The Himalayan Health Exchange is 
a humanitarian program founded in 
1996 with the mission of providing 
medical and dental care to underserved 
people living in remote regions of the 
Himalayas and of uplifting two orphan- 
ages located in the northern Indian 
state of Himachal Pradesh. Each expe- 
dition offers participants a combina- 
tion of service and adventure. 

Since its founding, the exchange has 
run 14 health expeditions that have 
served between 1,100 and 1,700 patients 
on each trip. Expedition teams consist of 
no more than 16 participants and have 
included internists, pediatricians, sur- 
geons, ophthalmologists, cardiologists. 



gastroenterologists, dentists, nurses, 
medical students, and support person- 
nel. In addition to treating underserved 
populations, expedition members enjoy 
hiking trips and overland journeys rated 
on a scale ranging from mild to moderate 
to strenuous. 

The 2001 schedule of expeditions to 
the Tibetan borderlands and the Indian 
and Nepah Himalayas includes trips to: 
Dharamsala, home to the fourteenth 
Dalai Lama, with a visit to the Taj Mahal; 
Lukla, Nepal, with a trek to the Everest 
Base Camp; Ladakh, in the Indian 
Himalayas; Chang Thang Plateau, along 
the Indo-Tibetan border with a visit to 
Tso-Morari Lake, located at an altitude 
of 15,000 feet; Spiti-Dharamsala, also 
known as the ancient Tibetan kingdom 
of "Guge"; and Goa, founded as a six- 
teenth-century Portuguese colony on 
the west coast of India and renowned for 
its beautiful clear-water beaches. ■ 

Beverly Ballaro is associate editor of the 
Harvard Medical Alumni Bulletin. 



MEDICINE 



t 



tt 



X 



Wilderness 
Medical Society 

3595 East Fountain Blvd. 

Suite A-1 

Colorado Springs, CO 80910 

Phone:719-572-9255 

Fax: 719-572-1514 

www.wms.org 

International Society 
of Travel Medicine 

P.O. Box 871089 

Stone Mountain, GA 30087 

Phone: 770-736-7060 

Fax: 770-736-6732 

www.istm.org 



International Society of 
Aquatic Medicine 

6240 Turtle Hall Drive 
Wilmington, NC 28409 
Phone: 910-452-1542 
www.divingdocs.org 

Mountain Rescue Association 

PO. Box 501 
Poway, CA 92074 
v/ww. mra.org 

Himalayan Health Exchange 

PO. Box 610 
Decatur, GA 30031 
Phone: 888-278-8735 
wv/w. himalayanhealth.com 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



The newy disp ayed 
artifacts in Harvard's 
Warren Anatomica 

Museum revea 

both the outer limits 

and the ingenuity 

of medicine on 

the threshold of 

modernity 

by Virginia Hunt 



Operating with 
Carbolic Spray 

Joseph Lister (1827-1912), Glasgow, Scotland 



HOW DO YOU DISTINGUISH AN AUTHENTIC SHRUNKEN HUMAN HEAD 

from a fake? This inquiry was part of a day's work for the 
curators of the Warren Anatomical Museum. After years in 
storage, a selection of the museum's contents is j^ain on 
display, this time in the Countway Library of Medicine. The 
anatomical specimens may strike contemporary sensibilities 
as macabre, yet, historically, the collection served as an 
important teaching tool. As for the authenticity of shrunk- 
en heads, an abundance of lustrous hair is a dead giveaway. 
Visit the Countway for a ghmpse into the medical past. 




V 


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. 











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'.§#»« 






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Joseph Lister (1827-1912) was responsible for introducing 
effective techniques for antisepsis. He advocated the use of 
carbolic sprays, such as this one, during surgery. They proved 
unpopular with surgeons, however, because their contents were 
messy and smelled unpleasant, and Lister eventually abandoned his 
invention. The antiseptic Listerine was later named in his honor. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



nburied treasures 



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FIRST DEMONSTRATION OF ETHER ANESTHESIA, 1846 

JOHN COLLINS WARREN'S GREATEST TRIUMPH OCCURRED IN THE FALL OF 

■V "H^^ 1846. After conducting his entire surgical career without the 
«*» rf^^ benefit of anesthesia, he heard about a young dentist, WiUiam 
T. G. Morton, who was extracting his patients' teeth painless- 
ly by having them inhale a secret ingredient called Letheon. 
wi^^^g^^^ j_ One of Warren's assistants, Henry Bigelow, called upon Mor- 
KC^^sfg JH ton to conduct a pubhc demonstration of his new invention. 
On October 13, 1846, Morton administered his preparation 
to Warren's patient, a 21'year'old painter who had visited 
Massachusetts General Hospital for the removal of a tumor 
on his neck. When the procedure was over, Warren famously 
exclaimed, "Gentlemen, this is no humbug!" 

Morton later tried to patent his mysterious anesthesia. 
Yet Warren, fearful of the risks to his patients, refused to 
continue using the secret substance unless Morton 
disclosed the exact contents. Morton confessed 
that Letheon was merely ether disguised with red 
coloring and aromatic flavors. 
Charles Jackson, a chemist who had supphed 
Morton with ether and suggested he use it to allay 
his patients' pain, attempted to claim for himself the 
discovery of ether anesthesia. The controversy still lingers. 



I 



J 



Virginia Hunt is curatorial assistant for the Warren Anatomical Museum at the Francis A. Countway Library of Medicine. For more information about the museum. 






PHINEASGAGE, 1823-1860 

IN 1848, AN ACCIDENTAL EXPLOSION PROPELLED A 13'P0UND TAMPING 
iron straight through the head of a railroad construction fore- 
man, Pliineas Gage. The rod pierced his face just under his left 
cheek, exited through the top of his skuU, and landed several 
yards away. The accident destroyed the front part of the left side 
of Gage's brain. Incredibly, almost immediately after the accident, he 
was conscious and able to talk and walk. After ten weeks of treatment, 
he returned home to Lebanon, New Hampshire. 

Unfortunately, Gage's recovery was not a complete success. The once 
weU-Kked man became "fitful, irreverent, and grossly profane." Those 
who knew him before the accident said he was "no longer Gage." The 
miracle of Phineas Gage illustrates an early medical insight into the 
relationship between personahty and the frontal lobe of the brain. 




Binaural Stethoscope 

George Cammann, 1852 

The monaural stethoscope became obsolete by 

the 1 860s, after George Cammann invented the 

binaural stethoscope, a bell-shaped chest piece 

attached to tv/o long air-conduction tubes 

that provided an increase of sound to 

both ears simultaneously. This original 

stethoscope's ear knobs are made 

of ivory, and the chest piece of 

ebony. Used by Henry Ingersoll 

Bowditch, it is inscribed v«^ith 

both Cammann's and 

Bov^ditch's names. 



S - m 




.m 





Monaural Stethoscope 

Rat Laamcc, 1819 

In 1816, Rene Laennec, an expert 
in chest diseases, vs^os examining 
a young v\^oman vnth heart prob- v 
lems. Painfully shy, he could not ^ 

bring himself to press his ear to her V \ '•. 

chest, the only knovm method of auscul- * 

tation. Remembering a childhood trick of scratch- 
ing the end of a log with a pin to transmit a sound, 
loud and clear, from one end to the other, he made a 
"log" by rolling sheets of paper into a cylinder. He 
applied one end to the woman's chest and the other to 
his ear and v^as surprised by the clarity of her heartbeat. 
This led, in 1819, to his invention of the monaural stetho- 
scope, a solid wooden cylinder v^ith a drilled center that 
could be unscrev\^ed for carrying in the pocket. At one 
end, a chest piece auscultated the heart; v\^en the chest 
piece was removed, the large opening could be used to 
listen to the lungs. By the 1 850s, Laennec's stethoscope 
had become a mainstay of the physical examination. 




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isitM/ww.countway.harvard.cdu/rarchoohs/warrcnmuscum.warrm.html. 



HARVARD MEDICAL ALUMNI BULLETIN 




The Rocky Mountain West tantalized nineteenth-century American settlers with twin 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER^iffOI 



FOR T 



by Betty Anne 
Johnson 





N AUGUST 1911, MY GRANDFATHER, GUS BECK- 

mann, stepped off the train at the depot 
in Powell, Wyoming, the small boom 
town that had sprung up at the center 
of the Shoshone Dam Project. Excite- 
ment charged the air. The hotels were 
overflowing with continually arriving new 
settlers attracted by the homesteading 
opportunities. Commercial buildings were 



being rushed to completion, and the 
main street bustled, a local reporter 
wrote, with "great, strong, stalwart, 
well-dressed and intelligent-looking 
men" who exuded a spirit of enthusi- 
asm and optimism for the future of the 
town and the Shoshone Project. 

Gus instantly fell in love with the 
wide-open, semi-arid rolling plains 
that surrounded Powell. Earlier, a 
Wyoming State immigration agent 
had rhapsodized about the beauty of 
the place: "I am of the opinion that 
God Almighty made Wyoming during 
the latter part of the week, for surely 
he could not have turned out such a 
fine job without four or five days' prac- 
tice. It is without a doubt one of the 
grandest and most resourceful states 
in the union and, so far as I have seen, 
there is not a better country, all things 
considered, than this new, undevel- 
oped, awkward, crude, big, grand, glo- 
rious, wild, picturesque Wyoming." 

Sagebrush, bunch grass, and cactus 
covered Gus's newly adopted land, 
which provided a haven for rat- 
tlesnakes, jack rabbits, coyotes, sage 
hens, and prong-horned antelope. 
Where settlers had developed home- 
stead claims lay neat, green, fenced-in 



fields with irrigation ditches and an 
acre or two set aside for the farmhouse 
and vegetable garden. The Flat, as this 
high plains desert would come to be 
known, was ringed by spectacular 
mountains on all sides, including 
Heart Mountain to the west, a craggy, 
limestone-capped peak that would 
later come to symbolize the town and 
the area. The dry, thin air, tangy with 
the scent of sage, made it seem possi- 
ble to see forever. 

Go West, Young Man 

The clean, rarefied atmosphere of 
Wyoming held powerful appeal for 
Gus. Like many settlers, he had trav- 
eled west seeking not just adventure 
and opportunity, but also improved 
health. The notion that the climate of 
the Rocky Mountain West was con- 
ducive to excellent health had enjoyed 
wide currency ever since Mark Twain, 
in his 1872 autobiographical account, 
Roughing It, had published a description 
of the region around Lake Tahoe: "I 
know a man who went there to die. 
But he made a failure of it. He was a 
skeleton when he came, and could 
barely stand. He had no appetite, and 






48 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 




O, PIONEERS: Clockwise from top 
left: A. Edith and Junior Beckmann 
B. The Beckmanns, circa 1925: Anna, 
Edith, Junior, and Gus C. Gus Beckmann 
at age 1 9 D. Anna Zippel at age 23 



did nothing but read tracts and reflect 
on the future. Three months later he 
was sleeping out of doors regularly, 
eating all he could hold, three times a 
day, and chasing game over mountains 
three thousand feet high for recreation. 
And he was a skeleton no longer, but 
weighed part of a ton. This is no fancy 
sketch, but the truth. His disease was 
consumption. I confidently commend 
his experience to other skeletons." In 
the decades following Twain's pro- 
nouncement, many health seekers and 
their families had made the journey 
west, most notably to New Mexico, 
Colorado, and — to a lesser extent — 
Nevada, Utah, and Wyoming. 

The experience of illness had dri- 
ven Gus west, too. The first-born son 
of German immigrants, he had grown 
up on a farm in the American Bottom, 
a low, level area in southwestern Illi- 
nois. The land in the Bottom, although 
made rich for farming by the repeated 
flooding of the Mississippi River, was 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



49 




iiilffl*' ':-:j** 



swampy, and the local climate damp. 
Typhoid, malaria, and tuberculosis 
ran rampant. Years later, Gus would 
recall with a shiver the nasty taste of 
quinine, which he had taken for the 
malaria he had suffered while living in 
the Bottom. 

Within a few weeks of his arrival in 
Wyoming, Gus filed on a homestead 
immediately north of the town of 
Powell and joined approximately 300 
families who had already settled upon 
government homestead land within a 
six-mile radius of town. For the next 
two years, he sent long, descriptive. 



enthusiastic letters home to his sweet- 
heart, Anna Zippel, trying to persuade 
her to join him on the Project. He 
wrote of the gorgeous landscapes, 
the economic opportunities, and, of 
course, the healthy atmosphere. 

For Anna, whose sister and half 
brother had died of tuberculosis, the 
promise of good health must have 
exerted particular attraction. But 
Anna, a six-foot, dark-haired beauty, 
also the daughter of German immi- 
grants, was not at all sure she wanted 
to leave her close-knit family and 
move to the other side of the world. 



even if it was irrigated. In the end, 
though, Gus's powerfully worded let- 
ters won her over. When she finally 
left home for the frontier, she was 
married to a man she knew largely 
through correspondence. 

Frontier Medicine 



In 1911, the raw frontier town in 
which newlyweds Gus and Anna 
would set about building a life was 
very much a work in progress. Powell 
had a local government, a chamber of 
commerce, schools, and churches. But 



SIGNS OF THE TIMES 

Public health notices and 
advertisements gave health 
advice to residents of 
Wyoming's developing frontier. 




LORE OF THE FLIES: The 
role of the housefly in 
the spread of typhoid v/as 
greatly exaggerated. Con- 
sumers 'were urged to buy 
fly s>vatters, fly paper, fly 
poison, flytraps, and >vin- 
dow and door screens. 



50 



The Doctors Say 

If you wish to preserve your 
health you MUST SWAT 
the FLY . 

ONE Hy killed sow mrxnt dath to 

tbonnnds before fall. 

Do year share lo mike this a Byleu 

cotomoniiy. 

G«i a FLY SWATTER, a FLY TB.^P. 

FLY PAPER and FLY POISON at 

Watson-Longlcy Hdw. Co. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



"I am of the opinion that God Almighty made Wyoming 
during the latter part of the week, for surely he could not have 
turned out such a fine job without four or five days' practice." 



many of the attributes of modern civi- 
lization had yet to be estaUished, 
chief among them provision for ade- 
quate health care and the establish- 
ment of public health ordinances. The 
town had attracted a number of 
physicians, despite this assertion by 
the editor of the local newspaper: 
"The Powell valley looks anything but 
flattering to members of the medical 
profession as our people never get 
sick. Doctors and undertakers will 
find Powell hard sledding; everybody 
else will prosper in comparatively 
abundant measure." 

The first doctor on the Project was 
likely an unlicensed homeopath, who 
also co-owned the drugstore. By 1911, 
two licensed physicians had settled on 
the Project, subsidizing their medical 
practices with other enterprises. No 
hospital existed until 1915, when a 
graduate nurse from Philadelphia 
established one in a rented cottage. 
Although it had no operating room, 
laboratory, or x-ray facilities, it pro- 
vided a haven for women during their 
confinement and allowed supervised 
nursing care for the sick and injured. 

The Wyoming State Board of 
Health approved rules and regulations 
governing not only the licensing of 
physicians, but also the containment 
of contagious diseases. By 1906, when 
the Pure Food and Drug Act was 
enacted, Wyoming had appointed a 
dairy, food, and oil commissioner, as 



well as a state chemist. Together, they 
collected and analyzed samples of 
canned foods, soft drinks, whiskey, 
dairy products, drugs, oH, and water 
to assure purity and accuracy of label- 
ing. The commissioner traveled the 
state inspecting creameries, meat mar- 
kets, hotels, restaurants, well water, 
and town water. The Pure Food and 
Drug Act met with skepticism at first, 
particularly on the part of merchants, 
but consumers endorsed it heartHy as 
evidenced by excerpts from a ditty 
popular at the time; 



To market, to market, and what 
shall we huy^ 

The bread trod upon hy the germ- 
hearingfly? 

Shall we buy from the dealer who 
keeps his best rice 

In an open receptacle harboring 
mice^. 

Thanks to the Project's largely rural 
setting and the small size of the town, 
epidemics of the sort that plagued 
large cities remained relatively 
uncommon. Yet Project life carried its 
own unique hazards. The major caus- 
es of morbidity and mortality were 
dam and canal construction acci- 
dents, blasting and farming mishaps, 
injuries created by runaway teams of 
horses, rattlesnake bites, bear attacks, 
and drownings. 



Shoo, Fly, Shoo 

The settlers in Gus's community had 
to contend with a host of contagious 
ailments, including enteric diseases, 
most notably typhoid. Infections caus- 
ing diarrhea, such as dysentery, were 
common. Children developed "sum- 
mer complaint," for example, when 
they waded in running water, whether 
streams, rivers, canals, or irrigation 
ditches. The settlers also suffered from 
respiratory diseases such as smallpox, 
diphtheria, scarlet fever, measles, 
whooping cough, and influenza. To 
help contain the spread of contagious 
illnesses, local physicians and county 
health officers adopted three main 
public health strategies: sanitation, 
isolation, and vaccination. 

The story of sanitation is largely the 
story of the containment of typhoid 
fever. Early on, the United States Recla- 
mation Service (USRS) had recognized 
the danger of typhoid fever as a pubhc 
health menace. A 1907 outbreak at a 
construction camp just five miles from 
Powell resulted in burials "day and 
night." Construction workers were 
often typhoid carriers, leaving a trail of 
deathly ill coworkers in their wake 
as they moved from camp to camp. 
Although the source of most typhoid 
epidemics was contaminated water and, 
to a much lesser extent, a contaminated 
milk supply, many well-meaning public 
health officials exaggerated the role of 



i 



DR. STRANGELOVE: Harvey 
Washington Wiley, chief 
chemist of the U.S. Depart- 
ment of Agriculture, demon- 
strates qsculatio antiseptica, 
or sanitary kissing, v/hich 
never caught on. 




NOTHING TO SNEEZE AT: A 
notice advising sick people 
to avoid spreading germs 
states, "Coughing, Sneezing 
or Spitting Will Not Be 
Permitted in the Theatre. 
In case you must cough or 
sneeze, do so in your own 
handkerchief." 



nmanu cmpumteo witk 

PNEUMONIA 

a ptmuiiT n nis iik moiiEHiiii iimu 

nEMiMscuniunK iitii iw upunui » HUini 

TOD HOST DO THE SAME 



ir TOV B»tt k o 

sscmiic- DO I 



in iBC c&ccsivc I 



GOHOKIHOGOTOBGDiNIirOUIKWai 



TtU> Tbeaira bAa acrcoi %o cooperate intb 

the DepttTtmenl Of HeRlili id diasamlnatuiK 

ilie truib About lallueaiA. and tbua aerv* 

• ereai educBUooaJ purpose 

HELP VS TO KEEP CHICAGO THE 
HEALTHIEST CTTT Dt TBS WORLD 
JOHN DILL ROBERTSON 

ooMiniftaiONefi or ncactm 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



Swatting flies became a civic duty, and schoolchildren 
were awarded prizes for bringing in the most quarts of flies. 



the housefly in spreading typhoid. The 
press eagerly seized the "dangerous 
housefly" theme and ran article after 
article, asserting that the housefly "is 
known to carry the germs of typhoid 
fever, tuberculosis, dysentery, cholera, 
cholera infantum — in fact, any danger- 
ous bacterial disease with which it 
comes in contact." The "filth theory of 
disease" made sense to the pubhc, who 
enthusiastically embraced "Swat the 
Fly" campaigns. 

Baby hy 
Here's a fly! 
Let us kill him 
You and I 
Ere he crawls 
Up the walls 
And dire ill hefalls 

1 believe on those six legs 
Are a billion typhoid eggs 
There he goes 
On his toes 
Tickling Baby's nose 
Now we must run right away 
For the antiseptic spray 
To sterilize where the fly's 
little microbes stray 

People waged war against the fly 
on many fronts. Privy vaults were dug 
deep, with screens erected and sand 
thrown in daily, or chloride of lime 
weekly. Kitchens, dining tents, and 
meathouses were screened; one set- 
tler recalled the frequent sight of an 
antelope hanging in the screened 
USRS meathouse outside the govern- 
ment eatery. 

Swatting flies became a civic duty, 
and schoolchildren were awarded 
prizes for bringing in the most quarts 
of flies. Flytraps, fly catchers, and fly 
swatters were sure draws at the local 
hardware store, whose owners urged 
each family to keep a fly swatter in 
every room in the house. Even The 
Lancet was quoted in the local newspa- 
per: "The best and simplest fly killer is 



a weak solution of formaldehyde in 
water (two teaspoonfuls to the pint). 
Place in plates or saucers throughout 
the house. Ten cents worth of for- 
maldehyde will last an ordinary family 
all summer." The Montana State Board 
of Health issued a "fly bulletin" wdth a 
recipe for "New Dope for Flies." The 
recipe, similar to that proposed by The 
Lancet, was enhanced by placing slices 
of bread in saucers to encourage flies to 
alight and feed. The bulletin stated 
that 40,000 fhes — or four quarts — had 
been killed with the mixture between 
noon on one day and eight o'clock the 
next morning. 

During this time, "sanitary" became 
a popular buzzword both in Wyoming 
and nationwide. Powell boasted a Sani- 
tary Meat Market, a Sanitary Creamery, 
a Sanitary Grocery, and a Sanitary Soda 
Fountain. Harvey Washington Wiley, 
chief chemist of the U.S. Department of 
Agriculture — who was largely respon- 
sible for the passage of the Pure Food 
and Drug Act — even demonstrated 
osculatio antiseptica, or sanitary kissing, 
which, somehow, just never caught on. 
In the end, however, pubhc health offi- 
cials gradually realized that the major 
source of typhoid epidemics was not 
the common housefly but a contami- 
nated water supply. 

Not a Drop to Drink 

Ironically, one of the most enduring 
problems the early settlers on the Pro- 
ject faced was finding an adequate 
supply of clean water. The USRS had 
arranged for a seemingly inexhaustible 
supply of irrigation water for crops 
and gardens but had made no provi- 
sion for water for drinking or house- 
hold use. To his consternation, Gus, 
who had fled to Wyoming in part 
because of a severe drought that 
afflicted his previous home, found that 
the well on his homestead overflowed 
with alkali-poisoned water as the 
water table rose. Even the chickens 



refused to drink it. Until the town 
waterworks went in, he was forced to 
haul water from the well in town, and 
Anna collected rainwater from the 
gutters because the water on the Pro- 
ject was so hard with mineral salts. 

During the summer, settlers either 
hauled or piped their water from the 
irrigation canals, but this source dried 
up in the fall when the USRS turned 
the water off. Other settlers drilled 
wells, but by the end of the 1909 farm- 
ing season, a new problem arose: all 
over the Project, the topsoil was rela- 
tively alkaline and the ground water 
table relatively high. When water was 
applied in amounts sufficient to grow 
crops, the ground water rose and con- 




■ - ■ -'I 



centrated alkali salts in the root zone, 
killing or damaging the crops. 

The settlers who were lucky 
enough to live close to the Shoshone 
River hauled their water from the river 
in 50-gallon barrels. But obtaining 
canal or river water for drinking pur- 
poses was time consuming. After the 
water had been hauled or piped to the 



52 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 





C^^c 




^.-■/■f u 



V** <>s>l« 



house, the settlers had to remove large 
particles, then use charcoal filters to 
remove the smaller solids. Water was 
poured through charcoal into deep cis- 
terns and thereafter, if plumbing had 
been installed in the house, the water 
was pumped into the house and 
through a faucet to which a flannel 
bag full of charcoal had been attached. 



The bag was periodically removed, to 
allow the charcoal to be baked and the 
flannel to be washed. 

Unfortunately, not every settler was 
willing to engage in all of the requisite 
steps to assure the purity of the drink- 
ing water. Furthermore, no formal pro- 
vision was made for the disposal of 
sewage except in individually owned 



LITTLE HOUSE ON THE PRAIRIE: A. Edith 
and Gus Beckmann's original home- 
stead. B. A picture of do>vnto>vn 
Povvrell in 191 1, when it was just on 
its v/ay to becoming a boom town. 



privies or septic systems. A pri\'y or 
leaky septic system located near a set- 
tler's well could quickly result in a 
typhoid outbreak, if the settlers 
neglected to boil or treat their drinking 
water. Such was the case in PoweU in 
the fall of 1915, prior to the installation 
of the town waterworks, when towns- 
people, including schoolchildren, began 
falling ill with typhoid. As a result of 
this outbreak, the citizens were warned 
not to drink water from any town wells, 
an admonition that served as the final 
impetus for the implementation of Pow- 
ell's waterworks, which were installed 
in the winter of 1915. 

Danger in the Air 

While new sanitation efforts helped 
contain typhoid outbreaks, isolation 
and vaccination were used primarily to 
contain respiratory diseases. Smallpox 
cases were dealt with swiftly and 
severely. Infected people were subjected 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



One of their children contracted measles and the household 
was subjected to a quarantine until the infection passed. 



to "absolute quarantine" either in a 
"pest house," a building constructed 
just for the purpose of isolation, or 
within their own homes, which were 
placarded with quarantine notices. 
Absolute quarantine meant that only 
physicians and immune family mem- 
bers were allowed to enter the premis- 
es of the patients. Vaccination and 
quarantining of those exposed to a 
smallpox case also were mandated, and 
reentry to society could take place only 
after the incubation period of the dis- 
ease had been exceeded and thorough 
disinfection of the infected people, 
their clothing, and their personal prop- 
erty had taken place. 

People with diphtheria also were iso- 
lated, but in "modified quarantine," usu- 
ally within their homes. These patients 
were treated with diphtheria antitoxin 
and allowed to reenter society two 
weeks after complete resolution of their 
symptoms. Measles, whooping cough, 
and scarlet fever cases also were quaran- 
tined in the home; Gus experienced this 
firsthand when, before he brought Anna 
west, he rented his house to a family 
who cooked and cleaned for him. One of 
their children contracted measles and 
the household was subjected to a quar- 
antine until the infection passed. 

Scarlet fever quarantines were the 
most problematic, because family mem- 
bers of the infected were not allowed 
back in school until 30 days after recov- 
ery of the infected. Settlers often tried to 
hide infected family members. This issue 
came to a head when the newspaper 
reported a case of scarlet fever, noting 
that no physician had been called to the 
home and no quarantine was being 
observed. Before the doctor could even 
investigate, he had to obtain permission 
from the county health officer in Cody. 
Having done so, he showed up uninvited 
at the home and put up the requisite 
ticket, but the family continued to vio- 
late the quarantine. 

It would not be long, however, 
before the value of quarantining 



became universally accepted in terms 
of isolation of the sick as well as reverse 
quarantining — that is, isolation of the 
healthy. Although unrecognized at the 
time, the first death on the Project from 
the influenza pandemic of 1918-19 was 
probably the Beckmanns' next-door 
neighbor. Otto Schacht, the local baker, 
who died in the spring of 1918 at the age 
of 31. Schacht had become iU while car- 
ing for his ailing father in Ilhnois, and 
returned to the Project to be treated in 
the local hospital. His obituary notes 
that he was critically iU from the start 
and death came svdftly. Notably, his 
father, presumably ffl with the same 
infection, survived, accenting what 
later came to be universally accepted as 
true, that this influenza virus was most 
virulent to those in the prime of Iffe. 

The second wave of the influenza 
pandemic hit PoweU in November 1918, 
but because of immediate and complete 
action by the county health officer and 
the local physicians in response to 
directives from the State Board of 
Health, Powell emerged unscathed 
compared to other Wyoming commu- 
nities. Whereas other cities engaged in 
"Dorit spit, don't sneeze" campaigns or 
promoted the use of gauze face masks 
and ineffective vaccines, Powell simply 
shut down, and pubhc gatherings of 
any kind were prohibited from October 
1918 through January 1919. 

An Ounce of Prevention 



Over time, the State Board of Health 
focused on preventive medicine rather 
than just the investigation and manage- 
ment of outbreaks. In 1915, Wyoming 
passed a law requiring schoolteachers 
to perform an eye, ear, nose, and throat 
examination on each student at the 
beginning of each school year based on 
such issues as whether pus or a foul 
odor proceeded from either ear, or 
whether the pupil was a habitual 
mouth breather. If any of the questions 
was answered in the affirmative, the 



schoolteacher was instructed to send a 
report to the student's parents, but the 
law provided for no further action. 

Gradually, more physicians moved 
into PoweU. One of these, a surgeon, 
built a modern hospital, complete vwth 
laboratory, x-ray machine, and operating 
room, and saved many a sick and injured 
PoweU settler from a four-hour train 
ride to Billings, Montana. Pubhc health 
nursing, with its emphasis on health 
education and maternal and infant 
hygiene, flourished after the passage in 
1921 of the Sheppard-Towner Act, which 
caUed for state and federal funding to 
promote prenatal and postnatal care. 
Civilization had finaUy arrived. 

In the end, though, whUe civUiza- 
tion triumphed, the dream of good 
health that had drawn Gus Beckmann 
and his famUy to the promised land of 
Wyoming proved elusive. Gus died in 
1926 at the age of 39 after a bout of 
influenza complicated by pneumonia. 
After two weeks in the hospital, he had 
recovered from the pneumonia; his 
farmly was en route to pick him up 
when he abruptly arrested, probably of 
a massive pulmonary embolus, before 
the stricken eyes of his attending 
nurse. Gus's son. Junior, drowned at 
the age of 28 in a local reservoir, part of 
the same irrigation system that had 
given hfe to the Project. Gus's wife, 
Anna, struggled with severe asthma 
her entire life, and their daughter, 
Edith, contracted rheumatic fever in 
the pre -penicillin 1930s. Yet these 
events could have happened anywhere. 
Somehow it made them less tragic to 
have unfolded in pursuit of a cherished 
dream to tame this "new, undeveloped, 
awkward, crude, big, grand, glorious, 
vvdld, picturesque Wyoming." ■ 

Betty Anne Johnson 79 is professor of medi- 
cine at Virginia Commonwealth University 
School of Medicine. The daughter of Edith 
Beckmann, she grew up on Gus Beckmann's 
homestead, for which she is seeking a Nation- 
al Historic Register listing. 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



ATJIMNA PROFTT.F 



NAWAL NOUR '94 




Providing Care for Circumcised Women 



s A YOXJNG GIRL GROWING UP On mtercourse, difficult childbirth, and 
in Egypt and the Sudan, many other symptoms. 
Nawal Nour '94 encountered The exact origins of the procedure are 

a cultural tradition that unknown. "Some people say that it orig- 
would have a far-reaching influence in inated in ancient Greece, ancient Rome, 
her hfe, leading her to enroll at HMS and, Czarist Russia," Nour says. "We just 
later, to found a chnic for African women, don't know." Regardless of its origins. 
That tradition, the practice 
known as female circumcision or 
female genital mutilation, is one 
that Nour is now committed to 
helping eradicate. She travels 
throughout the United States 
conducting workshops to edu- 
cate African refugees on the 
medical and legal issues sur- 
rounding the practice. She cre- 
ated a slide-lecture kit to teach 
physicians about the medical 
management of circumcised 
women. And every Friday morn- 
ing, she sees patients from 
Boston's African community, 
primarily from Somalia, where 
the most severe form of female 
circumcision is performed. 

In many African countries, 
girls between the ages of five and 
twelve undergo female circumci- 
sion as a rite of passage. The pro- 
cedure can range from a slight 
nicking or burning of areas 
around the genitals to complete 
removal of all external genitalia, 
leaving a flat sheet of skin with a 
very small opening. Female cir- 
cumcision is carried out with 
special knives, scissors, scalpels, 
pieces of glass, or razor blades. 
The procedure generally lasts 15 
to 20 minutes. Anesthesia is not 
used. Immediate comphcations 
can include hemorrhage, infec- 
tion due to unhygienic conditions, shock 
due to bleeding and severe pain, and even 
death. Once the tissue has healed, cir- 
cumcised women have problems with 
menses, chronic bladder infections, pain 




SENSE AND SENSITIVITY: Nawal Nour promotes 
what she terms "culturally competent care" for 
African v^omen v/ho have been circumcised. 



the procedure has a strong cultural hold 
in many African countries, where cir- 
cumcision is believed to usher young 
girls into adulthood as virtuous and 
marriageable women. Nour remembers 



schoolmates talking about having their 
procedures done and about the accom- 
panying celebration, and asking her 
when her turn would come. But Nour's 
parents were strongly opposed to the 
practice. At age 14, she left Africa to 
attend high school at the American 
School in London. Nour received her 
undergraduate degree at Brown Univer- 
sity, where she focused on African 
women's issues and wrote her 
thesis on the emancipation of 
Egyptian women. And although 
she wasn't working directly on 
the issue of female circumcision, it 
was never far from her thoughts. 

Nour knew she wanted to work 
to improve conditions for women, 
but wasn't sure what approach to 
take — should she attack women's 
issues from a legal standpoint, by 
going to law school, or a health 
angle, by attending medical school? 
After reading One L, Scott Turow's 
harrowing tale of the Hfe of a first- 
year law student, Nour leaned 
toward medical school. She also 
realized that a medical degree 
would allow her to work more 
globally. "Medicine is such an inter- 
national skill," she points out. "I 
could go from one country to 
another and practice medicine, but 
that would be hard to do wdth law." 
After receiving her medical 
degree, Nour completed a chief res- 
idency in obstetrics and gynecolo- 
gy at Brigham and Women's Hos- 
pital in 1998. As her reputation in 
the community grew, more and 
more circumcised African women, 
particularly members of Boston's 
Somah community, began showing 
up at her practice. "Initially they 
just wanted to see a doctor who 
understood and didn't make a big 
deal about the fact that they were cir- 
cumcised," Nour says. 

Circumcised women often must deal 
with reactions of shock and horror when 
they are examined by doctors unfamiliar 



56 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2001 



with the procedure. Communication bar- 
riers can make the situation even worse, 
as frustrated health providers try to con- 
vey important information to patients 
who dorit speak the same language. Nour 
soon realized the value of a clinic specifi- 
cally designed to treat circumcised 
women, and the African Women's Health 
Practice opened at Brigham and Women's 
Hospital in July 1999. 

Nour sees about eight to ten patients a 
week in her Friday chnic, which is slowly 
beginning to spiU over into other days. 
Because most of her patients have under- 
gone Type III circumcision, the most 
severe form, Nour often performs a proce- 
dure called deinfibulation. She puts a 
patient under a spinal or general anesthe- 
sia, makes a vertical skin incision, and 
sutures the tissue on both sides. As a 
result, patients report that pain on menses, 
urination, and intercourse is greatly 
decreased. Difficulties with childbirth can 
be eliminated as well. 

But Nour also asks patients how they 
feel about the way they look after the 
surgery. "The majority of patients have 
been brought up to believe that to be cir- 
cumcised is to be more beautiful," she 
says, and the surgery results in a major 
change. This sensitivity to her patients' 
beliefs is at the heart of Nour's focus on 
"culturally competent care." 

Nour makes sure to involve husbands 
in the process whenever possible. "Female 
circumcision is a tradition that separates 
men and women, and I'm trying to bring 
the two together," she says. "I want dein- 
fibulation to be a joint decision; I want it 
to be something that they both get edu- 
cated about. Many times the men dorit 
understand the kind of pain that the 
women have undergone." Nour says that 
in most cases, the men are very willing to 
learn about the procedure. Some of them 
are extremely uncomfortable discussing 
it, but others "wiU actually ask many ques- 
tions and say, 'Thank you, I had no idea.'" 

In addition to caring for patients and 
teaching at HMS, Nour is committed to 
educating health providers and the gener- 



^^ L :ii 




CHANGE FROM WITHIN: Somali refugee women in the Hartisheik camp in Ethiopia 
display posters about female circumcision as part of an awareness campaign aimed 
at eradicating the practice. 



al public. "Female circumcision is a horri- 
ble tradition and it needs to be stopped," 
Nour says. "But health providers need to 
see each patient as an individual." Often 
circumcision can become the focus of a 
visit, when that was not what the patient 
intended. "Women who have been cir- 
cumcised are women who have other 
health problems and are coming to see a 
health provider for those problems." 

When Nour gives lectures to physi- 
cians, she displays slides of the various 
types of female circumcision, and then 
leaves up the shde of Type III for a long 
time. "I want you to get used to this," she 
teUs her audience. "Although it is horrible, 
you need to absorb it and understand your 
feelings about it, because you need to deal 
with those feelings outside the office. That 
way, when you see your patient, you're not 
going to bring those feelings in with you." 

Such efforts to increase awareness of 
female circumcision have begun in the 
United States only in recent years, as the 
African immigrant population in the 
country has increased. Nour's goal is ulti- 



mately to reach as many physicians as pos- 
sible. "If I can educate a large number of 
health providers on how to feel comfort- 
able providing this type of care, then we 
won't need specific chnics," she explains. 
Although she wants to continue pro- 
viding care to African women in her Fri- 
day chnic, in the future Nour also plans 
to concentrate on efforts to eradicate the 
procedure. "I'm hoping to do much more 
outreach nationally and internationally, 
to be able to network with other organi- 
zations," she says. When asked what she 
does in her spare time, Nour immediately 
responds that she travels a great deal — 
an interest closely linked to the issue she 
has made her life's work. She hopes to 
return to the Sudan sometime this com- 
ing year. Not surprisingly, the trip would 
be more than just a vacation. "There's a 
great center there," she explains, "where 
they work on issues related to female 
circumcision." ■ 

Susan Cassidy is assistant editor of the 
Harvard Medical Alumni Bulletin, 



WINTER 2001 • HARVARD MEDICAL ALUMNI BULLETIN 



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ABOVE: In Greenland, neurophysiologist 
S. Allen Counter >vorks 'with Inult hunters, 
v/hose hearing begins to deteriorate as 
soon as they start hunting 'with guns at 
the age of ten. 

FRONT COVER: Ophthalmologist Geoff 
Tabin summits Alaska's Mount McKinley, 
>vhose Athabascan name, Denali, has 
been adopted in mountaineering circles. 



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P rr O T, 

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